Health Net Weight Loss Prescription Coverage
Carrier Updates
Thursday, September 12 2024
Health Net has released criteria for Weight Loss Drugs and require prior approval based on their drug use guidelines.
For approval, Health Net Medical Necessity criteria must be met based on:
• BMI (Body Mass Index)
• Documentation of member’s baseline and current height and body weight within the last 30 days
• Other medical issues
• Documentation supporting member’s participation in a Health Net approved weight loss program (e.g., Weight Watchers) or other weight loss programs recommended by the prescriber that involves:
o a reduced calorie diet
o increased physical activity and
o behavioral modification.
To request prior authorization, the prescriber must complete and fax a Prior Authorization form (PDF) to 866-399-0929.
For More Information or Help Quoting Health Net, Please Contact Your Dickerson Sales Rep.
For approval, Health Net Medical Necessity criteria must be met based on:
• BMI (Body Mass Index)
• Documentation of member’s baseline and current height and body weight within the last 30 days
• Other medical issues
• Documentation supporting member’s participation in a Health Net approved weight loss program (e.g., Weight Watchers) or other weight loss programs recommended by the prescriber that involves:
o a reduced calorie diet
o increased physical activity and
o behavioral modification.
To request prior authorization, the prescriber must complete and fax a Prior Authorization form (PDF) to 866-399-0929.
For More Information or Help Quoting Health Net, Please Contact Your Dickerson Sales Rep.