Medical Necessity Checklist for Formulary Exception If you're requesting a formulary exception, gather this documentation first: Required Documentation for Exception Request Current BMI documentation (30 or 27 with comorbidity) Documented comorbidities with ICD-10 codes (medical diagnosis codes): Obesity Class I/II/III (E66.811, E66.812, E66.813) Hypertension (I10) Type 2 Diabetes (E11) Dyslipidemia/high cholesterol (E78.5) Obstructive Sleep Apnea (G47.33) Failed alternative treatments documented trials of: Phentermine or diethylpropion Qsymia or Contrave Semaglutide (Wegovy/Ozempic) for 6+ months Lifestyle modification records (diet/exercise program participation) Weight history showing chronic obesity (past 1-2 years) Letter of Medical Necessity from your Kaiser provider For more on prior auth documentation, see our Wegovy prior authorization guide EXCEPTION PATHWAYS How Some Members Get Coverage While standard coverage is limited, some Kaiser members do get Wegovy covered
Loss of the autophagy protein Atg16L1 enhances endotoxin-induced IL-1 production
Then you can see if there are deficiencies and discuss areas of concern in your life, such as being vegetarian or being in menopause
Whether it works for a specific individual depends on the undisclosed formula, transdermal absorption efficiency, individual physiology, and lifestyle
Autoantibodies to the thyrotropin receptor
9 Despite its severity, DN has received comparatively less attention in clinical research and therapeutic development than other diabetic complications, such as nephropathy and retinopathy, necessitating further research
