Landing Page:https://www.vida.com/sutterhealthplan/
Paying Org Selection: Sutter Health
Special Announcements: Please instruct members to check their Caremark.com portal for an active Prior Authorization (PA).
Checking CVS Prior Authorization (PA) Status
What members will see: The portal displays approval dates and pending PA statuses. Members opted into digital messaging will also receive status updates directly from CVS.
How to Route Based on PA Status:
If the member DOES NOT have an active PA (for Wegovy, Zepbound, Saxenda, Contrave, or Xenical): Advise the member to work with their prescribing physician to submit the PA request. Remind them they must also begin engaging with Vida and completing their monthly program requirements.
If the member DOES have an active PA: Escalate the ticket to Tier 2. During the current grace period (3/1 – 4/30), Tier 2 will notify the Account Manager, who will work directly with CVS to investigate why the member is unable to fill their prescription.
⚡️ Scan this immediately to ground the call.
- Launch Date: 3/1/2026
- Enrollment: B2B via CVS Lookup
- Prescribing Use Case: Use Case 1
- Vendor Transition: No
📚 Source of Truth Links:
- VP Card: Use this for administrative and operational checks (Eligibility, program offering, exclusions).
- Devices: Use Standard Device Criteria or Clinical Device FAQs Vendor Transition members DO NOT automatically receive a device form
-
Prescribing Overview: Use this for clinical inquiries. It houses all Pharmacy Benefits information, including Drug Coverage, formularies, and specific GLP-1 details.
🚀 B2B Eligibility ("Can I Join?")
✅ Eligible - Employees, spouses, and dependents 18+
❌ Not Eligible direct to call the number on the back of their insurance cards.
💊 Clinical Care & Pharmacy ("The Meds")
| Category | Rule | Notes for Support |
|---|---|---|
| GLP-1 Coverage | Not Covered | No prescribing |
| Gold Card Status | NO | No prescribing |
| Formulary | PBM: CVS Caremark | No prescribing |
| Medication Transition | Timeframe to enroll and engage to keep PA active. | 60 days starting 3/1/2026 (Members who have been on the medication for fewer than 120 days prior to 3/1/26 fall under the 'Members who are NEW to weight loss medication' category.) The member must be currently taking the medication. |
| Use Case | Use Case 1 | GLP-1 Companion |
| Engagement Requirements | Must complete to maintain PA |
Provider interaction: Completes a consultation with a Vida provider or participates in a synchronous group coaching session 1 time per month and Biometric monitoring: Measures and records a health goal or outcome metric either manually or through a connected device 1 time per week, 3 out of 4 weeks and Self-paced learning: Completes a program unit or related educational content (e.g., lesson, health screener, content card, worksheet, guided video) 1 time per week, 2 out of 4 weeks
|
Members do not choose whether they are in a group or individual program. At enrollment, the system automatically assigns them to either the MWL Group Path (typically for grandfathered members) or the MWL 1:1 Path.
Monthly Compliance & The "Fallback" Rule
To remain active and compliant in the program, members must engage monthly.
The Fallback Rule: If a member cannot find any available appointments on the in-app calendar for the current month, they can attend a webinar session to fulfill their monthly engagement requirement.
Webinar Logistics & Zoom Links
Attending webinar sessions requires a manual process from the member.
Webinar schedules and Zoom links are located in an in-app Content Card.
Agent Guidance: Advise members that they must manually add the event to their personal calendar (e.g., Google or Apple Calendar) and save the link, or they will need to locate the Content Card in the app again at the time of the meeting.
Agent Talking Points: Clarifying Member Confusion
Use these talking points to resolve common areas of confusion for transition members:
| Member Confusion | What the Agent Should Say (Talking Point) |
|---|---|
| "Who manages my weight loss medication?" | "Vida will not be prescribing or refilling your medication. You do not need to book an appointment with a Vida provider for medication management; please continue to work with your primary prescriber for those needs." |
| "What is the difference between my Group Moderator and a 1:1 RD?" | "The difference is minimal. The group moderator is a Registered Dietitian (RD) who acts strictly as a group facilitator for webinars and group sessions. The 1:1 RD is a state-licensed Dietitian who provides individualized, one-on-one care." |
| "Do I have to attend a group session to keep getting my medication?" | "Group sessions are not related to your medication prescriptions. However, to stay active in the Vida program, you must engage monthly. If you cannot find an available 1:1 appointment this month in the app, you can elect to attend a webinar session to meet your monthly program goal." |
Comments
0 comments
Please sign in to leave a comment.