Employer / Commercial Insurance
Covered with requirementsWhat you need to qualify
- Age 18 and older
- BMI of 30 or higher
- BMI of 27 or higher with a weight-related condition (HTN, T2DM, dyslipidemia, OSA, CVD, and MASH)
- BMI of 23 or higher for patients of Asian descent
Qualification pathways
You can qualify through any one of these.
Adult obesity
All of:
- Age >= 18 years
- BMI >= 30 kg/m2
Adult overweight with comorbidity
All of:
- Age >= 18 years
- BMI >= 27 kg/m2
Plus any one of:
- Hypertension
- T2DM
- dyslipidemia
- OSA
- CVD
- MASH
Asian adult overweight/obesity
All of:
- BMI >= 23 kg/m2 (South Asian, Southeast Asian, or East Asian adults)
Documentation to bring
- Baseline BMI documentation (>= 30 kg/m2 for obesity, or >= 27 kg/m2 for overweight)
- Documentation of weight-related comorbidity if BMI 27–29.9 kg/m2
- Age documentation (>= 18 years)
Approval and renewal
- To renew, the plan looks for at least 5% weight loss from the starting weight, Continuation recommended only for patients achieving at least 5% weight loss and tolerating therapy, assessed after 12 weeks at a therapeutic dose, and at least 12 weeks on therapy before the first renewal. Make sure your starting weight and date are in the chart now — renewal is measured against it.
Not covered when
- Coadministration with other tirzepatide-containing products not recommended
- Coadministration with any GLP-1 receptor agonist not recommended
Policy note: Available as both subcutaneous injection solution vial and Kwikpen formulations. Efficacy assessed after 12 weeks at therapeutic dose; continuation only if >= 5% weight loss achieved and therapy tolerated.
Policy effective May 4, 2026 · verified June 2, 2026 · source: RI_Weight_Management_ProgSum.pdf