What is prior authorization?

Prior authorization (PA) is the insurance step where your plan reviews whether your GLP-1 prescription meets coverage criteria before it'll pay — required for almost every GLP-1.

Prior authorization (PA) is the insurance step where your plan reviews whether your GLP-1 prescription meets coverage criteria before it'll pay — required for almost every GLP-1. Typical PA criteria for weight-management GLP-1s (Wegovy, Zepbound): BMI ≥30, or ≥27 with a documented weight-related condition (hypertension, dyslipidemia, sleep apnea, etc.), plus prior lifestyle-intervention attempts. Type-2-diabetes GLP-1s (Ozempic, Mounjaro) typically need a confirmed type-2 diagnosis (A1c documentation) and often a step-therapy requirement (must have tried metformin first). Your prescriber's office submits the PA. Denials can usually be appealed — many denials are template responses and reverse on the first appeal with the right clinical notes.

Related pages

• Does insurance cover Wegovy?
• GLP-1 glossary

Get the GLPeak app

Download GLPeak on the App Store · Get GLPeak on Google Play