CVS Health offers a multifaceted approach to weight management, emphasizing lifestyle changes and personalized support. This article will delve into the specifics of the CVS Weight Management program, its features, and its potential benefits, while also addressing important considerations regarding coverage and clinical policies.
A Lifestyle-First Approach to Weight Management
The CVS Weight Management program distinguishes itself by prioritizing lifestyle modifications. This approach acknowledges that sustainable weight loss is best achieved through a combination of healthy eating habits, regular physical activity, and ongoing support. The program's core tenet is focusing on the member as an individual.
Personalized Support from Registered Dietitians
A cornerstone of the CVS Weight Management program is the regular interaction between members and registered dietitians (RDs) who specialize in weight management. For members with diabetes, the program offers the added benefit of pairing them with an RD certified in diabetes care and education (CDCES). In some instances, members may also have the opportunity to work with a cardiovascular registered nurse (CVD RN).
Once physical activity is cleared by their physician, each member collaborates with their registered dietitian (RD) to develop a unique, personalized plan. This plan is tailored to the individual's specific needs and takes into account various factors, including:
- Health and fitness abilities
- Goals
- Motivation levels
- Limitations
Diet-Agnostic Approach
CVS Weight Management embraces a diet-agnostic approach, meaning it does not prescribe a specific dietary regimen. Instead, the program focuses on helping members make informed food choices and develop sustainable eating habits that align with their individual preferences and needs.
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Optimizing GLP-1 Effectiveness
According to Dr. Michelle Gourdine, Chief Medical Officer, CVS Caremark, “The data are clear: GLP-1 weight-loss drugs work best when combined with nutrition, lifestyle support and proper dosing.” The CVS Weight Management program aims to optimize the effectiveness of GLP-1s for weight loss by providing a clinically rigorous solution that incorporates these essential elements.
Measurable Results
The CVS Weight Management program has demonstrated promising results. As of February 1, 2025, the program was available to more than 3 million CVS Caremark plan members. Data indicates that before program enrollment, nearly 30% of members had lost less than 1 percent body weight on anti-obesity medication. However, after enrollment in the CVS Weight Management program, these same members experienced an average body weight loss of 11.7%.
Aetna Clinical Policy Bulletins (CPBs): Important Considerations
Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. It is crucial to understand the role and limitations of these bulletins.
- Treating providers are solely responsible for medical advice and treatment of members.
- While the Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits.
- The Clinical Policy Bulletins (CPBs) express Aetna's determination of whether certain services or supplies are medically necessary, experimental, investigational, unproven, or cosmetic.
- Aetna makes no representations and accepts no liability with respect to the content of any external information cited or relied upon in the Clinical Policy Bulletins (CPBs).
- The discussion, analysis, conclusions and positions reflected in the Clinical Policy Bulletins (CPBs), including any reference to a specific provider, product, process or service by name, trademark, manufacturer, constitute Aetna's opinion and are made without any intent to defame.
- CPBs include references to standard HIPAA compliant code sets to assist with search functions and to facilitate billing and payment for covered services.
- New and revised codes are added to the CPBs as they are updated. When billing, you must use the most appropriate code as of the effective date of the submission.
Understanding Benefit Plan Coverage
It is essential to recognize that each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Members and their providers will need to consult the member's benefit plan to determine if there are any exclusions or other benefit limitations applicable to this service or supply. The conclusion that a particular service or supply is medically necessary does not constitute a representation or warranty that this service or supply is covered (i.e., will be paid for by Aetna) for a particular member. The member's benefit plan determines coverage. Some plans exclude coverage for services or supplies that Aetna considers medically necessary.
Reviewing CPBs with Providers
Since Clinical Policy Bulletins (CPBs) can be highly technical and are designed to be used by our professional staff in making clinical determinations in connection with coverage decisions, members should review these Bulletins with their providers so they may fully understand our policies. While Clinical Policy Bulletins (CPBs) define Aetna's clinical policy, medical necessity determinations in connection with coverage decisions are made on a case by case basis.
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Appealing Coverage Determinations
In the event that a member disagrees with a coverage determination, Aetna provides its members with the right to appeal the decision. In addition, a member may have an opportunity for an independent external review of coverage denials based on medical necessity or regarding the experimental and investigational status when the service or supply in question for which the member is financially responsible is $500 or greater.
CPT Codes and Usage
The five-character codes included in the Aetna Clinical Policy Bulletins (CPBs) are obtained from Current Procedural Terminology (CPT®), copyright 2015 by the American Medical Association (AMA). The responsibility for the content of Aetna Clinical Policy Bulletins (CPBs) is with Aetna and no endorsement by the AMA is intended or should be implied. The AMA disclaims responsibility for any consequences or liability attributable or related to any use, nonuse or interpretation of information contained in Aetna Clinical Policy Bulletins (CPBs). No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. Any use of CPT outside of Aetna Clinical Policy Bulletins (CPBs) should refer to the most current Current Procedural Terminology which contains the complete and most current listing of CPT codes and descriptive terms. CPT only copyright 2015 American Medical Association. All Rights Reserved. Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. License to use CPT for any use not authorized herein must be obtained through the American Medical Association, CPT Intellectual Property Services, 515 N. State Street, Chicago, Illinois 60610. This product includes CPT which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60610. CPT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to the implied warranties of merchantability and fitness for a particular purpose. No fee schedules, basic unit, relative values or related listings are included in CPT.
The American Medical Association (AMA) does not directly or indirectly practice medicine or dispense medical services. and no endorsement by the AMA is intended or implied. This Agreement will terminate upon notice if you violate its terms.
CVS Health: A Leading Health Solutions Company
CVS Health is a leading health solutions company, delivering care through its local presence, digital channels, and dedicated colleagues. The company's extensive network includes physicians, pharmacists, nurses, and nurse practitioners, all working to improve the health of communities across America. CVS Health helps people navigate the health care system by improving access, lowering costs, and being a trusted partner for every meaningful moment of health.
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