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The coverage is subject to prior authorization and typically requires: BMI above 30 or BMI above 27 with at least one obesity-related comorbidity Documented participation in a CMS-approved intensive behavioral therapy program (16 sessions over 6 months) No history of medullary thyroid carcinoma or multiple endocrine neoplasia syndrome type 2 Cardiovascular disease or high cardiovascular risk (required for some plans following the SELECT trial data showing cardiovascular benefit with semaglutide) The cost-sharing structure: even when covered, Medicare Advantage members typically pay 25-33% coinsurance for specialty-tier medications, which translates to $337-$445 monthly for Wegovy

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The comparison of means between groups were performed employing Tukey-Kramer post hoc test