How do I appeal an insurance denial for GLP-1 medication?

When insurance denies coverage for a GLP-1 medication, you have the right to file an appeal. Start by requesting a written explanation of the denial and the specific criteria not met. Your healthcare provider must then submit additional documentation addressing those gaps, which may include lab results, BMI calculations, comorbidity documentation, or letters of medical necessity.

Most insurers have internal appeal processes that typically take 30-60 days for a decision. If the internal appeal is denied, you may have the right to an external review by an independent third party. Some states have additional appeal rights and protections. Documentation should emphasize medical necessity, potential health risks of not treating, and why alternative treatments are inappropriate or have failed.