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.
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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