Weight Management Drugs
PDL Reference Documents
- Nonalcoholic steatohepatitis (NASH) - Aug 01, 2024
- Wegovy (semaglutide) PA Update - Aug 01, 2024
- Semaglutide Prior Authorization Update - Jun 06, 2024
- Drugs for Weight Management - Apr 04, 2024
- New Drug Evaluation: Belviq (lorcaserin hydrochloride), Qsymia (phentermine and topiramate extended release) - Nov 29, 2012
Newsletters
- January 2025 - Off-label Uses of GLP-1 Receptor Agonists and Dual GLP-1/GIP Receptor Agonists
- October 2024 - New and Emerging Therapies for Metabolic Dysfunction-Associated Steatotic Liver Disease/Metabolic Dysfunction-Associated Steatohepatitis (MASLD/MASH) in Adults
- July 2024 - Lifestyle Modifications for Obesity: Recommendations and Benefits
- September 2023 - An Update in Weight Loss Therapies - Including FDA Approved GLP-1 Receptor Agonists
- November 2015 - Obesity and Related Sequelae: Are Medications the Answer?
- December 2012 - The Future of Newer Obesity Medications
PDL Status Values
Y = preferred
N = non-preferred. Non-preferred drugs listed as N but without clinical drug use criteria are subject to the
Non-Preferred Drugs in Select PDL Classes prior authorization criteria.
New drugs will be listed as N until reviewed by the P&T Committee and are subject to the
New Drug Policy.
V = voluntary non-preferred. Non-preferred mental health drugs are listed as V and prior authorization is not required.
Null (i.e. blank) = indicates the class or specific drug has not been reviewed for PDL placement.
To request a Prior Authorization, please use this form.
| Generic Name | Brand Name | Form | PDL Status |
Current Drug Use Criteria | New Drug Evaluation & Updates |
|---|---|---|---|---|---|
| liraglutide | SAXENDA | PEN INJCTR | N | PA Document | Mar 31, 2016 |
| benzphetamine HCl | BENZPHETAMINE HCL | TABLET | PA Document | ||
| diethylpropion HCl | DIETHYLPROPION HCL | TABLET | PA Document | ||
| diethylpropion HCl | DIETHYLPROPION HCL ER | TABLET ER | PA Document | ||
| orlistat | ORLISTAT | CAPSULE | PA Document | ||
| orlistat | XENICAL | CAPSULE | PA Document | ||
| phendimetrazine tartrate | PHENDIMETRAZINE TARTRATE ER | CAPSULE ER | PA Document | ||
| phendimetrazine tartrate | PHENDIMETRAZINE TARTRATE | TABLET | PA Document | ||
| phentermine HCl | PHENTERMINE HCL | CAPSULE | PA Document | ||
| phentermine HCl | ADIPEX-P | TABLET | PA Document | ||
| phentermine HCl | PHENTERMINE HCL | TABLET | PA Document | ||
| phentermine HCl | LOMAIRA | TABLET | PA Document | ||
| semaglutide | WEGOVY | PEN INJCTR | PA Document | ||
| setmelanotide acetate | IMCIVREE | VIAL | PA Document | Apr 01, 2021 | |
| tirzepatide | ZEPBOUND | PEN INJCTR | PA Document | ||
| tirzepatide | ZEPBOUND | VIAL | PA Document |