What is prior authorization (PA)?

Prior authorization is an approval step before your insurance pays for a specific drug. For GLP-1 medications, PA is the rule, not the exception.

What insurance looks for

• BMI ≥ 30 (or ≥ 27 with comorbidity) for weight-loss indications.
• Documented prior weight-loss attempts (diet, exercise, sometimes prior medications).
• For diabetes indications: HbA1c documentation and step-therapy history.

If denied

• File an appeal — appeal success rates run 40–60% with proper documentation.
• Use our appeal letter generator to auto-draft a payer-specific letter with the right medical-necessity citations.
• Some plans allow peer-to-peer review where your prescriber speaks directly with the insurer's medical director.