Obesity is a serious health issue that often involves comorbid conditions such as diabetes, heart disease, and high blood pressure. As more patients seek help managing their weight, the use of medications is becoming more common. However, these medications aren’t right for everyone. That’s why it’s essential to understand each patient’s medical background when requesting prior authorization.

What you need to include

When submitting a prior authorization request for weight loss medication, providers should include the following clinical details:

• Body mass index (BMI)
• Previous weight loss attempts
• Related health conditions (e.g., diabetes, hypertension)
• Relevant psychological factors

This information helps ensure the medication is appropriate for the patient’s needs and meets Cigna Healthcare^® coverage criteria.^* Many of these medications are approved only when certain medical conditions are present, so complete clinical documentation is key.

Why it’s important

Well-informed and complete requests can minimize denials, which result in the need for providers to submit additional details through the appeal process.

The bigger picture

Tackling obesity requires more than just medication; it takes a full understanding of each patient’s situation. By sharing complete and accurate clinical information, providers can help ensure patients get the right treatment while supporting informed and timely coverage decisions.

For more information, including coverage policies for weight loss medications, please visit the Cigna for Health Care Professional portal CignaforHCP.com (Coverage Policies > Drug Policy A-Z Index).

*Benefit plans vary by employer, plan type, and eligibility. Please verify patient benefit eligibility for comprehensive details regarding coverage, including any exclusions.