The prior authorization (PA) criteria for GLP‑1 medications used for weight loss has been updated. The 2026 Spotlight publication stated that current users would be required to meet the new BMI requirement of 35 or higher once their existing prior authorization (PA) expired. This guidance has been revised.

Existing Users – Revised Guidance

Members who are currently using GLP 1 weight loss medications under an active PA, and remain continuously compliant, will not be required to meet the new BMI ≥ 35 criteria when their PA renews. Instead, existing users will continue to be evaluated under the previous criteria, which require an initial BMI of either:

  • BMI of 30 or greater, OR
  • BMI of 27 or greater with at least one qualifying comorbidity, including:
    • Hypertension
    • Diabetes
    • Dyslipidemia
    • Obstructive sleep apnea
    • Cardiovascular disease

All other applicable prior authorization requirements remain in effect.

New Users – Effective July 1, 2026

Any initial authorization request for GLP 1 therapy for weight loss submitted on or after July 1, 2026 must meet the new PA criteria, including:

  • Body Mass Index (BMI) of 35 or higher, and
  • All other applicable prior authorization requirements

 

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