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The prior authorization requirements for Medicare Advantage are typically stricter than commercial plans: A1C above 8% (higher threshold than commercial) Failed trials of metformin plus two other diabetes medications BMI above 27 Cardiovascular risk factors documented A 2025 analysis by the Medicare Payment Advisory Commission (MedPAC) found that only 12% of Medicare Advantage beneficiaries with type 2 diabetes who met clinical criteria for GLP-1 therapy actually received coverage approval
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