Wegovy — Highmark
cardiovascular risk reduction
Initial criteria
- Member has a Delaware Commercial fully-insured or Healthcare Reform plan.
- Product is being used for an FDA-approved indication other than the excluded indication.
- Member meets the cardiovascular risk reduction criteria in policy J-1388.
Reauthorization criteria
- Member continues to meet the cardiovascular risk reduction criteria in policy J-1388.
Approval duration
initiation: 7 months; continuation: 12 months