Provider information on our GLP-1 program

+   Knee osteoarthritis
+   Asthma
+   Chronic obstructive pulmonary disease
+   Cardiovascular disease
+   High blood pressure
+   High cholesterol
+   Non-alcoholic fatty liver disease
+   Obstructive sleep apnea
+   Polycystic ovarian syndrome
+   Type 2 diabetes

Being able to receive a prescription for a weight-loss medication is dependent on active enrollment and engagement with a lifestyle modification program and an active prior authorization. If your patient is not enrolled in a lifestyle modification program, they will receive directions for enrollment by mail shortly after the pharmacy first receives the prescription. If your patient is enrolled, it is important that they maintain active participation with the lifestyle modification program.
 
If the patient is currently enrolled and engaged with a lifestyle modification program, the prescription may require either a new or renewed coverage review. It’s important to note that the steps must be performed in order: first is lifestyle modification program enrollment, then prior authorization. Prior authorization cannot be completed prior to lifestyle modification program enrollment.

Based on your patient’s medication or medical history, one of our lifestyle modification program partners may have already reached out to them via email or mail with instructions. Your patient can log in at express-scripts.com/healthsolutions. Once logged in, they should select the Health Solutions tab at the top. Here your patient will find information on the lifestyle modification program(s) available to them as well as their access code and enrollment link.
 
If your patient has trouble enrolling, they should reach out to their lifestyle modification program support team.

No, your patient does not need to re-enroll in the lifestyle modification program if it’s with the same partner. If they are already using a lifestyle modification program, they’ll need to show active engagement with the program.

Active engagement is defined as four weigh-ins and four app engagements per month. App engagements are not restrictive or specifically defined because everyone’s journey is unique and different. An engagement can be a completed lesson, a conversation with the patient’s health coach, meal tracking, adding to a peer group conversation, completing an exercise goal or many other activities offered by the lifestyle modification program partner. A weigh-in simply requires the patient to step on the scale and allow it to record their weight for the day.

The patient’s coach will reach out to introduce themselves, and your patient will receive their scale and any additional equipment necessary based on the initial enrollment responses. For the first 30 days, simply enrolling is enough to meet the engagement requirements while the patient waits for their equipment.
 
You will need to submit a prior authorization for your patient after they meet the prerequisites as mentioned earlier in this FAQ (BMI requirements and enrollment in an Evernorth-contracted lifestyle management program). You may also help initiate this process by visiting the EviCore by Evernorth® portal at evicore.com or by calling Express Scripts at 800.417.1764 to arrange for a review. If you are unable to provide the required documentation, the patient’s prescription may be denied. If this occurs, the full cost of the medication would fall to your patient.
 
Once both requirements are met, the patient’s medication will be available to be filled at the pharmacy. Please remember that the prior authorization cannot be completed before your patient enrolls in a lifestyle modification program.

If your patient is already on a GLP-1, they will be required to enroll in a lifestyle modification program, and their coverage review will be re-evaluated based on the updated criteria. The patient’s access code and enrollment directions will be provided to your patient and are available on the Health Solutions portal at express-scripts.com/healthsolutions.

Currently there are no limits to how long your patient can be on their GLP-1 medication.

If medication is discontinued for any reason, your patient can still participate in our lifestyle modification program. Our partners will continue providing tools and education to make their transition off of GLP-1s successful.

If you have questions, call our team at 800.282.2881. We're here to help.