How we build and verify this data

Where the data comes from

Each record is built from the payer's own documents: prior-authorization policies, formulary and preferred-drug-list documents, and published medical policies. We keep the source document on file with its effective date. Where a state Medicaid program sets the criteria that its managed-care plans must follow, the plan's page resolves to the state policy and says so.

How a record is structured

Policies are written per indication, so we keep one record for each combination of medication, condition being treated, payer, and plan type. Each record holds the same normalized fields: BMI and A1C thresholds, qualifying conditions, step therapy and prior trials, required documentation, quantity limits, approval and renewal terms, exclusions, and the benefit condition when coverage depends on the employer's plan design.

What "verified" means

A record is published only after a member of our research team has confirmed each field against the source document. That review sets the record's verification date, which appears on every coverage page. The statistics above count only records with an explicit verification date; nothing is inferred from an edit timestamp.

Payer policies change often, some of them monthly. When a policy is re-reviewed, the record's verification date is updated and its prior provenance is preserved. We do not yet run automated change alerts; re-verification is a manual cadence, and the date on each page tells you how current it is.

How to read a coverage page

Covered with requirements.

The drug is a covered benefit for that condition and plan type once the listed criteria are documented.

Covered (preferred drug).

Covered, and the plan prefers this drug over alternatives in its class.

Depends on your plan's benefit.

The payer's clinical criteria apply only if the specific plan includes the benefit, which is often an optional employer add-on for weight-loss medications. Confirm the benefit before submitting.

Not covered.

The policy explicitly excludes the drug for that condition on that plan type. A prior authorization cannot override a benefit exclusion.

No policy on file.

We have not reviewed a policy for that combination. Silence is not a denial; it means we don't know yet.

Limitations

• Employer plan design overrides published clinical criteria. A plan can exclude a benefit entirely even when the payer publishes criteria for it.
• A payer can run several formularies whose rules differ. Coverage pages show the payer's default formulary and the card checker lets you pick another where one exists.
• This site summarizes written policy. It is not medical or legal advice and not a guarantee of coverage, payment, or approval.

Corrections

If a page disagrees with a policy you are looking at, email ben@agenteva.ai with the payer, drug, and document. We re-check the record against the source and update it with a new verification date.