All dosing is individualized: the ranges here represent typical physician-prescribed ranges, not a standard or approved protocol
Qsymia is a prescription medication used for chronic weight management in adults and children aged 12 and older
Comparators encompassed all eligible doses of tirzepatide and semaglutide, placebo, and other glucose-lowering drugs directly compared to tirzepatide and semaglutide in at least one trial
Standard PA criteria across payers typically include: Confirmed diagnosis of primary hyperlipidemia or HeFH or HoFH with supporting ICD-10 code Documented LDL-C level above payer-specified threshold (commonly 70 mg/dL or 100 mg/dL depending on cardiovascular risk category) Evidence of maximally tolerated statin therapy or documented statin intolerance Prescribing clinician is a cardiologist, lipidologist, or relevant specialist (some plans require specialist involvement) Previous trial of other LDL-lowering therapies (PCSK9 inhibitors or ezetimibe, plan-specific) Maintaining thorough PA documentation in secure patient records is essential for both initial approvals and denial appeals
In the CY 2026 OPPS/ASC proposed rule, we proposed an additional change to encourage faster resolution of HPT civil monetary penalties (CMPs) and to reduce the amount of a CMP, under certain conditions, when the hospital waives its right to an administrative law judge (ALJ) hearing