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Zepbound (tirzepatide) — CareFirst (Caremark)

Reduction of excess body weight or maintenance of weight reduction long term in adults with obesity or overweight with at least one weight-related comorbid condition

Initial criteria

  • The requested drug will be used with a reduced-calorie diet AND increased physical activity
  • The patient is 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 drug therapy
  • The patient meets ONE of the following: BMI ≥ 30 kg/m2 OR BMI ≥ 27 kg/m2 with at least ONE weight-related comorbid condition (e.g., hypertension, type 2 diabetes mellitus, dyslipidemia)

Reauthorization criteria

  • The requested drug will be used with a reduced-calorie diet AND increased physical activity
  • The patient is an adult
  • The patient has completed at least 3 months of therapy with the requested drug at a stable maintenance dose
  • 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: 8 months; Continuation: 12 months