benzphetamine products — CareFirst (Caremark)

Initial criteria

• The requested drug will be used with a reduced-calorie diet AND increased physical activity in the management of exogenous obesity
• The patient has NOT received 3 months of therapy with the requested drug within the past 365 days
• The patient has participated in a comprehensive weight management program that encourages behavioral modification, reduced-calorie diet, AND increased physical activity with continuing follow-up for at least 6 months prior to using drug therapy
• The patient has a baseline body mass index (BMI) ≥ 30 kg/m2 OR a baseline BMI ≥ 27 kg/m2 with at least one weight-related comorbid condition (e.g., hypertension, type 2 diabetes mellitus, dyslipidemia)

Approval duration

3 months (90 days of therapy) per year