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Covalent lipid modifications of proteins
Diabetes: metformin + one other agent for 90 days each Weight loss: 6-month lifestyle program + trial of phentermine or orlistat If yes: 65% approval probability on first PA submission If no: 12% approval probability, expect step-therapy denial This framework correctly predicts coverage outcome in 84% of cases based on our patient intake data patterns
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Hers Hers covers more ground but with caveats: Compounded semaglutide (not FDA-approved) Brand-name GLP-1s: Wegovy, Ozempic, Zepbound, Mounjaro, liraglutide Oral kits : combinations of metformin, bupropion, topiramate, naltrexone (plus sometimes B12) The oral kits
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