Health Net Shares Their Policy on Weight Loss Prescription Coverage

All weight loss drugs require prior approval based on Health Net’s drug use guidelines. 

For approval, Health Net Medical Necessity criteria must be met based on: 

• BMI (Body Mass Index) 
• Documentation of member’s baseline and current height and body weight within the last 30 days 
• Other medical issues 
• Documentation supporting member’s participation in a Health Net approved weight loss program (e.g., Weight Watchers) or other weight loss programs recommended by the prescriber that involves: 
  • a reduced calorie diet 
  • increased physical activity and 
  • behavioral modification. 

To request prior authorization, the prescriber must complete and fax a Prior Authorization form (PDF) to 866-399-0929. 

To access Pharmacy Prior Authorization Guidelines, please review Health Net Commercial Drug Coverage Policies resource site.