Metabolic Therapeutics
GLP-1 Coverage
Navigator.
Utah Pharmacoeconomic Decision Support Tool. Analyze insurance coverage likelihood based on current clinical policy and metabolic profile.
1Insurance Profile
Med (Broad): Integration with Intermountain Health. Broadest network in Utah.
2Clinical Profile
Coverage Analysis
Live Adjudication Logic
Ozempic
T2DM
T2DM diagnosis required for this medication. Using it for weight loss without T2DM is considered off-label and rarely covered.
Mounjaro
T2DM
T2DM diagnosis required for this medication. Using it for weight loss without T2DM is considered off-label and rarely covered.
Wegovy
Weight Loss / CV / MASH
Patient does not meet baseline BMI criteria for anti-obesity medications.
Zepbound
Weight Loss / OSA
Patient does not meet baseline BMI criteria for anti-obesity medications.
Strategic Checklist
- Document all comorbidities in the "History of Present Illness" (HPI) notes for PA submission.