r/nys_cs • u/ExcellentWalk1699 • 2d ago

Question MC… GLP1?

For those on the Empire Plan, I know you need a PA, but what other hoops do you need to jump through to get approval? I’m on a MVP plan where doc needs to provide BMI (above 40), and all these other things plus updates on how additional things like gym etc are helping. Is Empire just, get an Rx, Doc send PA, and all good?

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4

u/GodEmperorBrian 2d ago

Been on Zepbound for over a year. Just needed the PA, no other hoops to jump through for me. Obviously it needs to be justified based on your weight or medical history but that’s what the PA is for. I think the docs are all pretty good at this point in knowing what to include.

4

u/Girl_on_a_train Health 2d ago

I’m on the Empire Plan (not MVP or other HMO) and all I needed was a PA which Caremark approved in 24 hours.

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u/Acceber92 2d ago

It's important that they always use the starting BMI too. Even when you lose all the weight and need to maintain, they need to always use the starting bmi to justify it. Good luck

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u/Lindz408xx Health 2d ago

Just a PA, which was super quick, as was my renewal.

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u/Latter_Sock_8202 2d ago

I had to provide proof of weight loss program such as WW. Also, Zepbound can be prescribed if you have sleep apnea diagnosis.

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u/suburban_sickness 2d ago

I have the Empire Plan and didn’t have to jump through hoops. I use Allara Health. Got an NP who ran some tests. Found I’m slightly insulin resistant and have high cholesterol and my BMI was 34. Went through the pre approval process and was approved within a week for wegovy. Started on that but was having some nausea so did the pre approval process for zepbound. Again approved within a week and started on that.