Zepbound — Point32Health
weight management in adults with obesity or overweight with comorbid conditions
Initial criteria
- Patient age ≥ 18 years
- BMI ≥ 30 OR BMI 27–29 with ≥1 of the following: diabetes mellitus, hypertension, sleep apnea, hyperlipidemia, symptomatic osteoarthritis of lower extremities (knee or hip), GERD, or coronary heart disease (history of CABG, myocardial infarction, stroke, or angina)
- Used as an adjunct to lifestyle modification (dietary or caloric restriction, exercise, behavioral support, community-based program)
Reauthorization criteria
- Documented weight loss or maintenance of ≥5% of baseline body weight during first 6 months OR patient new to plan and stable on medication (baseline and follow‑up weights required)
- Prescriber documents adherence to lifestyle modification (dietary or caloric restriction, exercise, behavioral support, community-based program)
Approval duration
6 months initial, 12 months reauth