Saxenda — Cigna

Weight Loss, Adult

Initial criteria

Patient is age ≥ 18 years; AND
Patient has engaged in a trial of behavioral modification and dietary restriction for at least 3 months; AND
Patient meets ONE of the following (a or b): a) At baseline, patient had a BMI ≥ 32 kg/m2; OR b) Patient meets BOTH of the following: (1) At baseline, patient had a BMI ≥ 27 kg/m2; AND (2) At baseline, patient had, or currently has, at least TWO of the following weight-related comorbidities: hypertension, type 2 diabetes, dyslipidemia, obstructive sleep apnea, cardiovascular disease, knee osteoarthritis, asthma, chronic obstructive pulmonary disease, metabolic-dysfunction associated steatotic liver disease/non-alcoholic fatty liver disease, polycystic ovarian syndrome, or coronary artery disease; AND
The medication will be used concomitantly with behavioral modification and a reduced-calorie diet

Patient is age ≥ 18 years; AND
Patient meets ONE of the following (a or b): a) At baseline, patient had a BMI ≥ 32 kg/m2; OR b) Patient meets BOTH of the following: (1) At baseline, patient had a BMI ≥ 27 kg/m2; AND (2) At baseline, patient had, or currently has, at least TWO of the following weight-related comorbidities as defined above; AND
Patient has lost ≥ 4% of baseline body weight; AND
The medication will be used concomitantly with behavioral modification and a reduced-calorie diet

initial 4 months, reauth 1 year