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Originally developed for diabetes and obesity, these drugs also influence appetite regulation as well as reward-related brain pathways
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These plans follow Priority Health's standard medical policy for anti-obesity medications, which includes: Coverage for FDA-approved obesity drugs including Wegovy, Saxenda, and Qsymia Prior authorization required for all anti-obesity medications Step therapy requirements in most plan designs Quantity limits (typically four 0.25 mg, 0.5 mg, 1 mg, 1.7 mg, or 2.4 mg pens per 28 days) Tier 3 or Tier 4 formulary placement (specialty tier) Medicare Advantage plans through Priority Health follow federal Medicare Part D rules, which explicitly exclude coverage for weight loss medications under the Social Security Act Section 1862
