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The request must include: Patient demographics and Medical Mutual member ID Specific medication requested (Wegovy, Zepbound, or Saxenda) with dosing Current BMI calculation with height and weight List of weight-related comorbidities with supporting lab values or diagnoses 6-month weight history showing documented diet and exercise attempts Statement of medical necessity Attestation that patient has no contraindications Step 2: Medical Mutual clinical review (Days 1-7) A Medical Mutual clinical pharmacist or nurse reviews the submission against policy criteria
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