Updating its coverage criteria for the fourth time this quarter, UnitedPBM Health announced Monday that patients prescribed GLP-1 therapy must now complete Tier 4 Lifestyle Verification, which includes harvesting two acres of winter wheat by hand and swimming from Milwaukee to Muskegon.
“We want to be sure conservative measures have been exhausted,” said formulary vice president Todd Gable, from a forty-foot boat. “Conservative measures, in this case, being the lake.”
Patients who complete the swim must present a notarized affidavit from the water, a churned pound of butter, and three correct answers to a bridge troll, whose questions the company declined to share for fairness reasons.
Asked what happens to patients who develop a cardiac event during the ten-year review window, Gable said that was a separate form, and that the form was also in the lake.
The company confirmed Tier 5 is in development and will require applicants to have felt guilty continuously since 1996, with documentation.
At press time a patient in Grand Rapids had completed the swim, submitted the butter, and been denied for using the wrong cow.
