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WegovyCigna

Major Adverse Cardiovascular Event(s) Risk Reduction in a Patient with Established Cardiovascular Disease with Overweight or Obesity

Initial criteria

  • Patient is ≥ 18 years of age
  • Patient has a current BMI ≥ 27 kg/m2
  • Patient has had a prior myocardial infarction OR prior stroke (excluding transient ischemic attack) OR has a history of symptomatic peripheral arterial disease evidenced by ONE of: intermittent claudication with ankle-brachial index < 0.85, peripheral arterial revascularization procedure, or amputation due to atherosclerotic disease
  • According to the prescriber, the medication will be used in combination with optimized pharmacotherapy for established cardiovascular disease
  • The medication will be used concomitantly with behavioral modification and a reduced-calorie diet

Reauthorization criteria

  • Patient is ≥ 18 years of age
  • At baseline BMI ≥ 27 kg/m2
  • Patient continues to have established cardiovascular disease (myocardial infarction, stroke, or symptomatic peripheral arterial disease as defined)
  • According to the prescriber, Wegovy will be used in combination with optimized pharmacotherapy for established cardiovascular disease
  • The medication will be used concomitantly with behavioral modification and a reduced-calorie diet

Approval duration

1 year