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In CY 2026 PFS proposed rule (90 FR 32874 through 33255) we proposed to modify the quality performance category measure inventory, a set of 190 MIPS quality measures, for the CY 2026 performance period/2028 MIPS payment year, which included the following: Implementation of 5 new MIPS quality measures including 3 high priority measures, one of which is a patient reported outcome measure
Herbs & Holistic Health
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What payers require for Zepbound prior authorization Zepbound PA requirements are typically more stringent: Documented BMI of 30 or greater, or 27 or greater with at least one weight-related comorbidity Evidence of lifestyle intervention including documented participation in diet, exercise, and behavioral modification programs (usually for at least 3 to 6 months) Prior medication trials (some plans require documented failure of other weight management medications before approving tirzepatide) Specialist involvement (some plans require referral to or management by a bariatric medicine specialist, endocrinologist, or obesity medicine physician) Ongoing weight monitoring documentation with specific weight loss targets (typically 5% of baseline weight within 3 to 6 months of starting therapy) Patients researching BMI requirements for GLP-1 medications should understand that these thresholds directly correspond to the prior authorization criteria their provider must document
