For GLP-1 Medications Approved for Type 2 Diabetes Only:
Make sure the prior auth includes a visit with a provider for Type 2 Diabetes within 3 months of the script that would include an A1c test proving that the person requires the medication to help control their diabetes.
Due to the cost, require proof that they have tried alternative step therapies for at least 3 months prior to moving to these medications.
Many employers are also adding a requirement of participation in a lifestyle improvement program for 3 months prior to being on the medication and then during the full time while on the drug. This is much like what you might find pre bariatric surgery. The goal is to support the success of improving strategies to allow a person to maintain their health once they are off the medications.
Require a prior auth every 6 months with proof of improved A1c control. In the first 6 months, only allow for 1 month fill to prevent waste since about 12% of persons fail to stay on the medication after the first fill.
For Weight Loss:
Consider removing the coverage for these medications all together or at a minimum increasing the criteria to the most critical persons with a BMI of 40 or greater.
To show support for plan members, offer a lifestyle improvement program. VI strategist can provide suggestions of more effective solutions.
Require of participation in a lifestyle improvement program for 3 months prior to being on the medication and then during the full time while on the drug. This is much like what you might find pre bariatric surgery. The goal is to support the success of improving strategies to allow a person to maintain their health once they are off the medications. This can also be offered as a more cost effective support strategy instead of offering GLP-1 medications.
Require a prior auth every 6 months with proof of improved A1c control. In the first 6 months, only allow for 1 month fill to prevent waste since about 12% of persons fail to stay on the medication after the first fill.
