The Anti-Obesity Medication Policies applies to HMSA Federal Plan 87 Formulary and HMSA’s Postal Service Formulary.
| Policy Name | Notices | Current Effective Date | Policy # | Policy Notes | Archived Policies |
|---|---|---|---|---|---|
| Antiobesity Agents [PDF] | 08-2023 | 18-C UDR | PA with Limit | ||
| Contrave [PDF] | 08-2023 | 1190-C UDR | PA with Limit | ||
| Qsymia [PDF] | 08-2023 | 794-C UDR | PA with Limit | ||
| Saxenda [PDF] | 08-2023 | 1277-C UDR | PA with Limit | ||
| Wegovy [PDF] | 08-2023 | 4774-C UDR | PA with Limit | ARCHIVED – Wegovy | |
| Xenical [PDF] | 08-2023 | 250-C UDR | PA with Limit | ||
| Zepbound [PDF] | 11-2023 | 6192-C UDR | PA with Limit |
Revision History
| Date | Nature of Revision |
|---|---|
| 08/03/2026 | Migrated to new platform.
|