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For the beneficiary to qualify, a provider must submit a prior authorization request to the program that attests the beneficiary is prescribed the requested drug to reduce excess body weight and maintain weight reduction in combination with current and ongoing lifestyle modification including structured nutrition and physical activity consistent with the applicable FDA approved label, and the beneficiary is at least 18 years of age with a BMI greater than or equal to 35. For beneficiaries with underlying medical conditions, the BMI threshold is lowered to 30 or 25 based on the diagnosis

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Diagnosis: How is Vitamin B12 Deficiency Detected

This aligns with the pharmacology of cagrilintide as a dual amylin and calcitonin receptor agonist (DACRA), in which central satiety effects may predominate over peripheral emetic pathways, although mechanistic data remain limited (14)