GLP‑1 Playbook
Owner: Derek Sanz
Status: Draft · Needs Derek review
Last updated: 2026‑02‑14
1. Purpose
Equip clinic and pharmacy teams with a standardized GLP‑1 workflow covering candidate selection, titration, monitoring, and prior authorization (PA) evidence.
2. Candidate Identification
| Step | Requirement | Notes |
|---|---|---|
| BMI screen | ≥30 kg/m² or ≥27 with cardiometabolic risk | Document two consecutive weights |
| Disease burden | T2D, ASCVD, CKD, obesity | Capture ICD‑10 pairs |
| Contraindication review | MTC, MEN2, pancreatitis, severe gastroparesis | Confirm in problem list + consult notes |
| Payer prerequisites | Prior metformin/SGLT2 failure, lifestyle program | Upload RD/health coach documentation |
3. Baseline Dataset
- A1C, fasting glucose (≤90 days).
- CMP with eGFR, LFTs (≤6 months; <3 months if CKD).
- Vital signs + waist circumference (day of start).
- Pregnancy test for individuals with reproductive potential.
- Concomitant therapy plan (insulin, sulfonylurea down‑titration).
4. Titration Protocols
Semaglutide (Ozempic/Wegovy)
0.25 mg weekly ×4 weeks → 0.5 mg ×4 → 1 mg ×4 → 1.7 mg ×4 → maintenance (2 mg T2D / 2.4 mg obesity). Delay escalation if nausea >Grade 2 for ≥48 hrs.
Tirzepatide (Mounjaro/Zepbound)
2.5 mg ×4 weeks → 5 mg ×4 → escalate by 2.5 mg every ≥4 weeks to 10–15 mg. Pause uptitration if weight loss >5 lbs over two weeks with dizziness or hypotension.
5. Monitoring Cadence
| Week | Touchpoint | Responsibility |
|---|---|---|
| 0 | Education + GI mitigation plan | RN/Pharmacist |
| 1–4 | Weekly SMS/app check-in (GI, hydration) | Care navigator |
| 6 | Virtual visit, med adjustments | Pharmacist/APP |
| 12 | Clinic or telehealth visit with vitals + labs PRN | Provider |
| Quarterly | A1C (if diabetic), BMP, weight trend, PA renewal tracker | Pharmacist |
6. Risk Mitigation Framework
- Hold dose 7 days prior to anesthesia or prolonged fasting.
- Provide euglycemic DKA script for patients on SGLT2 inhibitors.
- Constipation ladder (fiber → PEG → RX) and diarrhea ladder with loperamide instructions.
- Pancreatitis red‑flag messaging (persistent severe abdominal pain ± vomiting) with after-hours call tree.
7. Prior Authorization Packet Checklist
- Diagnoses + ICD‑10 codes, CHADS‑VASc if relevant.
- Failed therapy grid (drug, start/stop dates, outcome).
- Documented lifestyle interventions (RD sessions, coaching, digital apps).
- Cardiometabolic risk summary (ASCVD risk %, CKD stage, HF class).
- GLP‑1 consent/education acknowledgment.
8. Outcomes Dashboard Template
| Metric | Baseline | 3 mo | 6 mo | 12 mo |
|---|---|---|---|---|
| Weight (lbs) | ||||
| % Weight change | ||||
| A1C (%) | ||||
| Systolic BP (mmHg) | ||||
| eGFR (mL/min) | ||||
| PA renewal due |
9. Patient Messaging Library
- GI onboarding: “Eat slowly, stop at first sign of fullness, and aim for 64 oz fluids/day.”
- Plateau coaching: “Expect slower loss after 6 months; reinforce resistance training + ≥80 g protein/day.”
- Surgery pause: “Skip the injection one week before your procedure to avoid anesthesia delays.”
Contact: pharmacy@sanzsolutions.com | 813‑XXX‑XXXX