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phendimetrazine tartrate tab — Blue Cross Blue Shield of Montana

weight loss

Initial criteria

  • Patient is an adult (age ≥ 18 years)
  • AND ONE of the following:
  • • Patient has diagnosis of obesity confirmed by pretreatment BMI ≥ 30 kg/m^2 OR BMI ≥ 25 kg/m^2 if patient is of South Asian, Southeast Asian, or East Asian descent
  • OR
  • • Patient has pretreatment BMI ≥ 27 kg/m^2 with at least one weight-related comorbidity/risk factor/complication (e.g., diabetes, dyslipidemia, coronary artery disease)