Zepbound and phentermine added to preferred drug list

Effective Jan. 1, 2025, the adult weight loss and obesity medications generic phentermine and Zepbound® (tirzepatide) are on our preferred drug list. These updates apply to UnitedHealthcare Community Plan of Massachusetts Senior Care Options and One Care plans only.

What you need to know

Prior authorization

• We require prior authorization for Zepbound
  • This applies to new users and users whose prior authorization is expired
  • Zepbound (tirzepatide) obesity and weight loss criteria include:
    • Diagnosis of obesity or overweight condition
    • 18 years or older
    • Baseline BMI of ≥30 kg/m2 or ≥27 kg/m2 with at least 1 weight-related comorbid condition
    • Baseline weight
    • Member has been counseled to continue a reduced-calorie diet and increased physical activity
• We don’t require prior authorization for phentermine
• We require prior authorization for Lomaira

Step therapy

• The step therapy requirements for Zepbound have changed
  • You do not need to trial Wegovy® (semaglutide) or Saxenda® (liraglutide) to request prior authorization for Zepbound
  • We require that new users trial phentermine with or without topiramate prior to requesting prior authorization for Zepbound

Coverage

• We’ll continue to cover Zepbound with prior authorization for obstructive sleep apnea
• Wegovy and Saxenda are no longer on our preferred drug list
  • We recommend that patients who are currently taking Wegovy or Saxenda switch to Zepbound for the remainder of their prior authorization
• We’ll continue to cover Wegovy with prior authorization for risk reduction of major adverse cardiovascular events in adults with established cardiovascular disease and either obesity or overweight conditions

Questions?

Connect with us through chat 24/7 in the UnitedHealthcare Provider Portal. If you have questions about prior authorization for these medications, please call Optum Rx® at 800-711-4555.