Appetite suppressants are not covered. Medical services are rendered to a member for the care and treatment of an injury or disease. While obesity can contribute to injury or disease, QualChoice/QCA Health Plan recognizes behavioral change such as diet or exercise rather than drugs to suppress appetite as the appropriate care for obesity. Correspondingly, appetite suppressant medication or dietary supplements are considered medically unnecessary and are excluded from coverage.
Biphetamine, Diethylporpion, Phendimetrazine, and Phentermine are all specific drugs indicated only for weight loss. There are other drugs such as Ritalin, Dexedrine, and Cylert which can also be prescribed for attention deficit disorder and narcolepsy as well as weight loss. Therefore, these drugs are covered by QualChoice/QCA Health Plan for the appropriate indications, but will be disallowed when prescribed for weight loss.
All claims for drugs on the formulary exclusions list are rejected if submitted to QualChoice/QCA.