PROVIDERS

The Health Care Authority’s mission is: We ensure that New Mexicans attain their highest level of health by providing whole-person, cost-effective, accessible, and high-quality health care and safety-net services.

Weight Reduction Medications

Weight Reduction Medications

Some weight loss medications for treating obesity are covered under the New Mexico Medicaid Fee-for-Service program with prior authorization.

Weight Reduction Medications

Covered, Prior Authorization Required

Not Covered by New Mexico Medicaid

Didres (benzphetamine)

Fastin (phentermine HCL)

Meridia (sibutramine HCL M-hydrate)

Sanorex (mazindol)

Tenuate (phendimetrazine)

Xenical (orlistat)

Imcivree (setmelanotide)

Saxenda (liraglutide)

Wegovy (semaglutide)

Zepbound (tirzepatide)

Prior Authorization Criteria

BMI >40 or BMI > 35 with additional risk factors (hypertension, diabetes, dyslipidemia), and
A six-month trial of caloric restriction and exercise is recommended (not required).

Prior Authorization Process

Providers: to obtain prior authorization, when necessary, fax MAD Form 303 to Medical Assistance division at 505-827-3185. Authorization is for an initial three-month period. Authorization for Meridia and Xenical is continued for a period of one year with significant weight loss (at least 3% body weight loss) and improvement of co-morbid conditions. Prior approval expires after a three-month period for all drugs indicated for short-term weight loss.

The New Mexico Medicaid program is approved to cover certain medications that are not typically covered by Medicare (see NMAC 8.324.4.12.A).

For more information contact: MADInfo.HCA@hca.nm.us