Benzinga - by AJ Fabino, Benzinga Staff Writer.
Shares of WW International Inc (NASDAQ:WW) spiked as much as 15% on Friday after Blue Cross Blue Shield of Michigan and Blue Care Network announced changes to the prior authorization coverage criteria for certain brand-name weight loss medications.
What Happened: Starting Oct. 1, Blue Cross Blue Shield (BCBS) of Michigan and Blue Care Network will implement changes to the prior authorization approval criteria for several weight loss drugs under commercial PPO and HMO plans. The adjustments are designed to promote healthy lifestyle modifications in tandem with pharmaceutical interventions.
Notably, while the implementation will impact several weight loss medications, one of the drugs on the list is Wegovy, a widely-utilized weight loss drug by Novo Nordisk A/S (NYSE:NVO).
Others include Contrave, Qsymia, Saxenda, and Xenical.
Weight Watchers Shares Surge: Unveiling New Qualifications
The revised policy mandates members to demonstrate engagement in lifestyle modifications for a minimum of six months prior to gaining approval for weight loss medication. BCBS said lifestyle modifications may range from participation in recognized weight loss programs like Noom and Weight Watchers, to adaptations in diet and exercise regimens under provider supervision.Providers are required to verify and attest to their patients' compliance with lifestyle interventions and ensure ongoing engagement after initiating therapy on weight loss drugs.
The adjustment in prior authorization criteria also forces providers to submit the current weight of the members, ensuring members meet the weight criteria to continue therapy.
The new approach is aimed at fostering the best results from weight loss drug therapy.
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Earlier this month, BCBS changed its prior authorization requirements for certain weight loss medications — including Wegovy — shortening the initial prior authorization approval duration from 12 months to four months for members initiating the therapies for the first time.
BCBS said providers should meticulously verify members' eligibility for weight loss drug coverage under their pharmacy benefit, as not all members are entitled to weight loss drug coverage under their pharmacy benefit.
Providers are encouraged to corroborate member eligibility prior to prescribing weight loss drug therapy, ensuring adherence to the revised policies, BCBS said.
WW Price action: Shares of Weight Watchers International closed 2.99% higher at $9.98 on Friday, earlier in the day the stock was trading lower and spiked as much as 15% on the news, according to Benzinga Pro. Shares of Novo Nordisk finished Friday’s trading session 0.01% higher at $91.30.
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