New GLP-1 Payment Rules for Providers

Payment determination is now required for GLP-1 medications (Mounjaro, Ozempic, Rybelsus, and Trulicity) to address potential misuse. 

Key Changes: 

• Payment Determination: All claims for GLP-1 medications now require payment determination. 

• Medications Affected: Mounjaro, Ozempic, Rybelsus, and Trulicity. 

• Claims Process: Claims are halted for payment determination. 

• Clinical Prior Authorization (PA): Required for Part D coverage. 

• Provider Action: Prescribers must initiate the PA process. 

Providers are encouraged to familiarize themselves with these requirements and initiate the PA process promptly to ensure seamless patient care. Please provide the diagnosis for use to allow for prompt review of these cases. For assistance, please contact the support team at 888-672-7205 or visit www.covermymeds.com.