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Coverage for GLP-1 medications under a POS plan will depend on whether your provider is in-network and whether prior authorization is required

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As tirzepatide and GLP-1 medications suppress appetite, calorie intake is greatly reduced in patients taking these medications for weight loss and blood sugar control, which can lead to low energy levels

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The patient must: Be age 18 or older Have eligible Medicare Part D coverage Be prescribed treatment specifically for weight reduction and maintenance Participate in ongoing nutrition and physical activity intervention Not have already received a GLP-1 through their Part D plan Not be seeking coverage for another Part D-coverable indication, such as type 2 diabetes, moderate-to-severe obstructive sleep apnea, MASH, or cardiovascular risk reduction The patient must also have met one of these criteria when GLP-1 therapy was originally started: BMI 35 BMI 30 plus HFpEF, uncontrolled hypertension despite 2 medications, or CKD stage 3a+ BMI 27 plus prediabetes, prior MI, prior stroke, or symptomatic peripheral artery disease Important: Eligibility is based on BMI at treatment initiation, not necessarily the patients current BMI