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Contrave — CareFirst (Caremark)

Chronic weight management in adults with BMI ≥ 30 kg/m2 (obese) or BMI ≥ 27 kg/m2 (overweight) with at least one weight-related comorbid condition such as hypertension, type 2 diabetes mellitus, or dyslipidemia

Initial criteria

  • The drug will be used with a reduced-calorie diet AND increased physical activity for chronic weight management in an adult
  • 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 the patient has a baseline BMI ≥ 27 kg/m2 with at least one weight-related comorbid condition (e.g., hypertension, type 2 diabetes mellitus, dyslipidemia)

Reauthorization criteria

  • The drug will be used with a reduced-calorie diet AND increased physical activity for chronic weight management in an adult
  • The patient has completed at least 4 months of therapy with the requested drug
  • The patient has lost at least 5 percent of baseline body weight OR has continued to maintain their initial 5 percent weight loss

Approval duration

Initial therapy: 4 months; Continuation therapy: 12 months