Prior Authorization of Weight-Loss Drugs Moving to CVS Caremark

Beginning December 1, 2023, the prior authorization review process for prescription weight-loss drugs will transition from Cooperative Benefit Administrators (CBA) to CVS Caremark™, NRECA’s pharmacy benefit manager.

As a result, starting November 27, CVS Caremark will send a letter to participants requesting prior authorization for a prescription weight-loss drug and their providers to inform them of the transition. After December 1, when a weight-loss drug is prescribed, letters will be sent to inform participants and providers that they have 30 days to request a prior authorization renewal.

Weight-loss drugs currently requiring prior authorization are Wegovy, Saxenda, Qsymia, Contrave, Xenical, benzphetamine products, diethylpropion products, phendimetrazine products and phentermine products.

Additionally, effective November 8, 2023, the Food and Drug Administration approved Zepbound (tirzepatide) as a weight-loss drug. Tirzepatide was initially approved in 2022, under the brand name Mounjaro, to treat Type 2 diabetes. Zepbound is expected to be available in the U.S. as early as December 2023. Zepbound, like all other weight-loss medications listed above, will require prior authorization under the plan.

If you or your employees have questions about prior authorization requests that are submitted to CVS Caremark on or after December 1, contact CVS Caremark Customer Care at 888.796.7322. Contact CBA for updates on prior authorization requests submitted before December 1.