\u2014documentation explaining why you need this medication. At that point, your plan will determine whether it will cover the drug.\u00a0<\/span><\/p>\nFor United Healthcare to initially approve Saxenda, they will confirm the following:<\/span><\/p>\n\n- The medicine is being used for appetite suppression or weight loss.<\/span><\/li>\n
- The patient is at least 12 years old.<\/span><\/li>\n
- The patient will be making lifestyle changes, such as a reduced-calorie <\/span>diet<\/span> and increased physical activity.<\/span><\/li>\n
- The patient\u2019s body mass index (BMI) meets the criteria for obesity. For adults, this is a BMI of 30 or more or of 27 or more with at least one weight-related medical condition, such as <\/span>Type 2 diabetes<\/span>, <\/span>sleep apnea<\/span>, high cholesterol, or high blood pressure. Pediatric patients need to have a BMI in the 95th percentile for their age and gender.<\/span><\/li>\n<\/ul>\n
If the plan approves <\/span>Saxenda<\/span>, the initial authorization is typically in place for four months.\u00a0<\/span><\/p>\nFor the plan to continue to authorize the medicine after this time, they will typically require:<\/span><\/p>\n\n- A weight loss of at least 4% (for example, an 8 lb. weight loss if your starting weight is 200 lbs.)<\/span><\/li>\n
- A continuation of lifestyle modifications<\/span><\/li>\n<\/ul>\n
This continued authorization is typically put in place for 12 months. Additionally, supply limits may apply. For example, some plans may cover a three-month supply, while others may approve a one-month supply with each prescription fill.<\/span><\/p>\nHow to get approved for Saxenda<\/span><\/h2>\nOnce you and your healthcare provider decide that you will start treatment with Saxenda, you may be eager to start the medicine and lose weight. However, the approval process may take some time. Your healthcare provider can send a prescription to your preferred pharmacy, and the pharmacy staff will submit your Saxenda prescription to your insurance company. At this point, one of these scenarios will occur:<\/span><\/p>\n\n- Your Saxenda prescription will be covered<\/b>. This is the best-case scenario. If the drug is not in stock, the pharmacy may take a day or two to order it.<\/span><\/li>\n
- Your prescription will require a PA<\/b>. If your plan requires a PA, your healthcare provider will send supporting documentation, such as your weight, lab results, and notes from your visit, to your health insurance company. The insurance company will review the information and determine whether it will cover the medicine. This may take a few days or even up to a week or two.\u00a0<\/span><\/li>\n
- Your plan will deny your prescription<\/b>. Some plans consider weight loss drugs (such as <\/span>Zepbound<\/span>, <\/span>Wegovy<\/span>, or Saxenda) to be <\/span>formulary<\/span> exclusions (not on the approved drug list) and do not cover them at all\u2014even if the healthcare provider submits a PA and explains that the drug is medically necessary.\u00a0<\/span><\/li>\n<\/ul>\n
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