Virginia Regulatory Town Hall
Department of Medical Assistance Services
Board of Medical Assistance Services
Guidance Document Change: This is a new form used to determine whether DMAS will cover certain weight loss drugs. (This process is called service authorization.)
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9/7/23  3:36 pm
Commenter: Anonymous

Weight Loss Management Drugs

I am an obesity medicine specialist and writing to reject the proposed changes being made to the prior authorization process for anti-obesity medications for the Virginia Medicaid population. I am concerned with the following proposed changes: 

Item 4: This is vague and somewhat antagonizing. Yes, obesity is life threatening over time when not properly treated; otherwise, VA Medicaid would not pay for bariatric surgery. 

Item 5: How could a patient try another GLP-1 RA prior to Wegovy or Saxenda if VA medicaid will not cover off label prescribing of GLP-1 RA?  

This prior authorization form is tedious, not geared towards the patient's benefit, and full of bias. The decision making process implemented in this form is not in alignment with any scientific information or the treatment recommendations from any medical society. 

CommentID: 220174