Diagnosis: Endocrine/Metabolic/Nutritional.
Treatment: Pharmacy/Prescription Drugs.
The insurer denied Saxenda.
The denial is upheld.

This is a female with pre-diabetes and obesity with body mass index of 35.8 kilograms per square meter (kg/m2). Request for continuation of Saxenda is under review. The prior request was denied as the patient was not actively engaged in a comprehensive medical weight loss program and the Saxenda is being used in combination with phentermine. The patient is back to being monitored in a comprehensive medical weight loss program with a dietician, health coach, medical doctor, and nurse practitioner. She is taking phentermine, Saxenda, and topiramate.

The health plan's determination is upheld.

The request for Saxenda is not medically necessary for this patient.
This request is for Saxenda for the treatment of obesity in combination with phentermine. In a randomized controlled trial, the addition of phentermine to Saxenda did not induce further weight loss as compared to Saxenda alone [1]. Therefore, no, the requested Saxenda 3 milligrams (mg) pen injection is not medically necessary for this patient.