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The roadmap makes it easier for Cincinnati residents to follow their plan with confidence
Many patients with high BMI and cholesterol concerns have shared their positive experiences with GLP-1 medications: After three months on a GLP-1 medication, my triglycerides dropped from 250 to 130, and my LDL went from 165 to 118
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If semaglutide is appropriate, youll begin with a low dose and gradually increase it over time
General PA criteria include: BMI threshold: BMI 30 (obesity), or BMI 27 with at least one weight-related comorbidity (type 2 diabetes, hypertension, hyperlipidemia, obstructive sleep apnea, or cardiovascular disease) Documentation of medical necessity: Clinical notes confirming obesity diagnosis, comorbidities, and treatment rationale from a licensed provider Prior lifestyle program participation: Many plans require documentation of participation in a structured diet and exercise program for a defined period (typically 36 months) before GLP-1 medications are authorized Non-diabetic indication: For Wegovy (semaglutide 2.4 mg) and Zepbound (tirzepatide weight loss dose), the weight management indication must be documented separately from diabetes management Step therapy: Some Cigna plans may require an oral agent (such as phentermine or Contrave) trial before authorizing higher-cost GLP-1 medications Ongoing authorization: GLP-1 PA approvals are typically renewable annually and may require documentation of 5% body weight reduction to continue coverage Klarity Healths clinical team may assist with the prior authorization process
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