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A few things to verify before billing Medicaid for any injection: State-level NCCI edits may differ from Medicare NCCI edits, so verify which NCCI version applies in your state Some states require prior authorization for GLP-1 agents, biologics, and extended-release injectables even when the federal Medicare standard doesn't Managed Medicaid plans operate under commercial contracts that often have different coverage rules than fee-for-service Medicaid Medicaid prior authorization requirements for injectable drugs are among the most variable in the payer landscape
A program that stays available for questions about side effects of GLP-1 medications, plateaus, or dose changes is worth more than one that only shows up at checkout
2023 Apr;84(2):316-321
GLP-1/GIP: How the Mechanisms Differ Why Tirzepatide Is One of the Best Weight Loss Drug Available Today The question of what constitutes the best weight loss drug on the market is no longer a matter of opinion, it is a matter of clinical evidence
