Clickable Table
Generic Name | Brand Name | Strength | Dosing | 90 Day Cost | Coverage | Comments | Category 1 | Category 2 |
---|---|---|---|---|---|---|---|---|
Liraglutide | Saxenda | 3 mg SQ | QD | $1450 | BC / NIHB - NC | C Obesity | Obesity | |
Orlistat | Xenical | 120 mg | TID | $595 | BC / NIHB - NC | C Obesity | Obesity | |
Semaglutide | Ozempic | 2.4 mg SQ | Once weekly | $1245 | NC for weight management |
Must titrate to 2.4 mg dose |
C Obesity | Obesity |
Semaglutide | Rybelsus | 14 mg | Once daily | $760 | BC - NC / NIHB - SA | C Obesity | Obesity | |
Semaglutide | Wegovy | 2.4 mg SQ | Once weekly | $1265 | BC / NIHB - NC | C Obesity | Obesity | |
Naltrexone | Contrave | 16 mg/180 mg | BID | $850 | BC / NIHB - NC | C Obesity | Obesity |