New digital resources for type 2 diabetes treatment and sustainable weight loss for some Priority Health commercial members
Beginning July 1, some Priority Health members with coverage through their employers will have access to digital health resources through Virta Health® for treating type 2 diabetes and losing weight sustainably. This is an optional buy-up benefit. Some members with the benefit may have a rider that adds GLP-1 coverage options for weight management to the formulary.
Why is Priority Health offering these resources?
Obesity and diabetes are prevalent and costly chronic conditions that present a major risk factors for other chronic diseases. We want to offer our members support for losing weight and putting their type 2 diabetes into remission.
How does Virta work?
Virta is a digital solution that offers our employers three programs, each including customized care plans with dedicated coaching based on biomarker data and on-demand access to clinician-led care teams:
- Sustainable Weight Loss: Helps members lose weight sustainably through nutrition therapy without medications
- Sustainable Weight Loss with Responsible Prescribing: Includes features of Sustainable Weight Loss and adds optimized GLP-1 use for weight loss via Virta’s Trusted Prescriber Network, with a path to a clinically monitored offramp
- Diabetes Reversal*: Offers members a way to put their type 2 diabetes into remission and reduce their blood sugar and diabetes medication through nutrition therapy
Each Virta solution focuses on nutrition therapy and lifestyle changes, personalized to each member’s preferences, budget and unique metabolic needs. All enrollees have 24/7 access to the tools and resources on Virta’s platform.
*Type 2 Diabetes Reversal on Virta is defined as reaching an A1c below 6.5% without the use of diabetes medications beyond metformin. Diabetes and related issues can return if lifestyle changes are not maintained.
Who’s eligible?
All members must be at least 18 years old to enroll in Virta and can only enroll in one Virta program. Here are the specific eligibility criteria for each program:
- Sustainable Weight Loss: BMI of 25+ or A1c of 5.7%–6.4%
- Sustainable Weight Loss with Responsible Prescribing: Meets FDA criteria for GLP-1s, including having a BMI of 30+ or 27+ with comorbidities
- Diabetes Reversal: A1c of 6.5%+ and diagnosed with type 2 diabetes
How is Virta different from Omada and Teladoc Health Condition Management?
Omada is focused on diabetes prevention for members diagnosed with pre-diabetes or at high risk of developing it. Teladoc aims to help members manage their type 2 diabetes.
Virta is a comprehensive solution to help members address obesity and prediabetes while putting their type 2 diabetes into remission. Virta empowers members to make lasting changes to nutrition and lifestyle. Members enrolled in Virta are supported by a multispecialty care team to help them fully engage in the program to achieve their health goals.
How and when do Virta providers communicate with a member’s provider?
Virta works as part of a member’s medical team and is committed to communicating with the member’s PCP. When a member enrolls, Virta asks the member for their PCP’s name and fax number. Virta then sends the PCP introductory information, followed by periodic member updates and triggered communications, such as if enrollees stop or start a medication or leave the Virta program. Providers can call, email or fax Virta, and they can set up a call with the member’s Virta care team, if desired.
How are GLP-1 prescriptions for weight loss handled?
If a member is enrolled in Virta’s Responsible Prescribing program, they can get coverage for GLP-1s subscribed for weight loss. All GLP-1 prescriptions for these members must come from a Virta provider. If members enrolled in Virta are given new GLP-1 prescriptions, their PCP will be notified.
Are GLP-1 prescriptions for diabetes impacted?
No, GLP-1 prescriptions for diabetes are not impacted, including for members enrolled in Virta’s Diabetes Reversal program. Their GLP-1 prescription will be covered as before, and their prescription will not need to go through Virta.
What can providers do?
Providers can refer eligible members who would benefit from Virta to virtahealth.com/join/priorityhealth. For more information, refer to our provider FAQs document.