BCBSM modifying weight loss drug coverage to require ‘lifestyle modifications’

Blue Cross Blue Shield of Michigan, or BCBSM, and Blue Care Network announced that starting Oct. 1, 2023, the groups will change the prior authorization approval criteria for commercial PPO and HMO plans for weight loss drugs that include Contrave, Evekeo, Qsymia, Saxenda, Wegovy and Xenical. The notice dated September 21 states: “Starting in October, members will be required to make lifestyle modifications for at least six months before they’re approved for weight loss drug therapy. Examples of lifestyle interventions include active participation in weight loss programs, such as Noom and WeightWatchers or active participation in other lifestyle modifications, such as diet and exercise, under the supervision of their provider.” WW (WW) is the maker and provider of the WeightWatchers program. Novo Nordisk (NVO), Eli Lilly (LLY) and Amgen (AMGN) market or are developing weight loss drugs.