QualChoice is amending or implementing new policies. Please see the table below for a list of these policies and their effective dates.
Medical Policy Number
Medical Policy Name
Effective Date of Change
Description of Changes
AR.QC.CP.CPA.359
Tirzepatide (Zepbound) - Citizen’s Bank Only
10/1/2026
Revised language for members with concurrent T2DM language from "failure" to "member has received optimal diabetic standard of care therapy as evidenced by a trial" to align with drug class; added new multi-dose vial dosage form and new KwikPen dosage form
Per June SDC: for initial and continued therapy, added if request is for Zepbound Pre-filled Single-Use Pen formulation, member must use Zepbound KwikPen formulation.
For questions about QualChoice Medical Coverage Policies, please contact your Provider Relations Representative at 800.235.7111 or 501.228.7111, Monday through Friday, 8:00 a.m. to 5:00 p.m.
