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Qsymia — Cigna

Weight Loss, Pediatric

Initial criteria

  • Patient has engaged in behavioral modification and dietary restriction for at least 3 months
  • At baseline, patient had body mass index (BMI) ≥ 95th percentile for age and sex (baseline refers to baseline prior to Qsymia)
  • Medication will be used concomitantly with behavioral modification and a reduced-calorie diet

Reauthorization criteria

  • At baseline, patient had body mass index (BMI) ≥ 95th percentile for age and sex (baseline refers to baseline prior to Qsymia)
  • Medication will be used concomitantly with behavioral modification and a reduced-calorie diet
  • Patient has had a reduction in BMI of ≥ 5% from baseline (baseline refers to baseline prior to Qsymia)