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The PA criteria across most BCBS licensees in 2026 require five things: BMI of 30 or higher, or BMI 27 to 29.9 with at least one weight-related comorbidity (type 2 diabetes, hypertension, dyslipidemia, OSA, or cardiovascular disease), documentation of a structured weight management program for at least 6 months in the past 24 months, prescriber attestation that lifestyle modification alone has been inadequate, age 18 or older, and concurrent reduced-calorie diet and increased physical activity
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Am J Physiol Lung Cell Mol Physiol 265: L374–L381, 1993
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