Clickable Table
| Generic Name | Brand Name | Strength | Dosing | 90 Day Cost | Coverage | Comments | Category 1 | Category 2 |
|---|---|---|---|---|---|---|---|---|
| Orlistat | Xenical | 120 mg | TID | $610 | BC / NIHB - NC | C Obesity | Obesity | |
| Tirzepatide | Zepbound | 10 mg SQ | Once weekly | $1125 | BC / NIHB - NC | C Obesity | Obesity | |
| Semaglutide | Ozempic | 2.4 mg SQ | Once weekly | $1300 | NC for weight management |
Must titrate to 2.4 mg dose |
C Obesity | Obesity |
| Liraglutide | Saxenda | 3 mg SQ | QD | $1485 | BC / NIHB - NC | C Obesity | Obesity | |
| Naltrexone | Contrave | 16 mg/180 mg | BID | $1010 | BC / NIHB - NC | C Obesity | Obesity | |
| Semaglutide | Wegovy | 2.4 mg SQ | Once weekly | $1485 | BC / NIHB - NC | C Obesity | Obesity |