Health Net’s Criteria for Weight Loss Drug Approval

Weight Loss Drugs Require Prior Approval

All weight loss drugs require prior approval based on Health Net’s 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:
  • a reduced calorie diet
  • increased physical activity and
  • behavioral modification.

To request prior authorization, the prescriber must complete and fax a Prior Authorization form to 866-399-0929.

To access Pharmacy Prior Authorization Guidelines, please refer to: Health Net Commercial Drug Coverage Policies | Health Net

To access the List of Covered Drugs based on your group size, please refer to: Employer Group Drug List | Health Net

For questions, please contact your Health Net Account Executive.