Anti-Obesity Agents Meridia - PDF document

. A therapeutic trial of samples of a Non-Formulary or Prior Authorization agent will not be accept ed as rationale for medical necessity to continue that agent. Please be sure to list all th erapies that have been previously tried o n the request form so that your request can be processed in a timely manner. x

A drug will be approved based on coverage criteria for FDA a pproved indications. Requests for newly approved indications will be reviewed by the Medical Director as per FDA labeling and an internal policy will be developed to assure consistency of review until an updated guideline is approved and published. x

Off-label/investigational uses will be reviewe d for medical appropriateness on a case by case basis. Literary evidence will be sought for well designed and well conduct