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This is the mechanism that blocks weight loss coverage: How the Diagnosis Code Edit Works When your pharmacy submits a Zepbound claim, Humana's system checks the ICD-10 diagnosis code

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For weight management in people without diabetes , NICE recommends considering semaglutide 2.4 mg (Wegovy) for adults with a BMI 35 kg/m (or lower thresholds for certain ethnic groups) and at least one weight-related comorbidity