What is prior authorization and how does it affect GLP-1 coverage?

Prior authorization is a requirement where your insurance company must approve the prescription before they'll cover it. For GLP-1 medications, this typically involves your healthcare provider submitting documentation proving you meet specific clinical criteria, such as a BMI threshold, documented comorbidities, or failure of previous weight loss attempts.

The prior authorization process can take anywhere from 24 hours to several weeks depending on your insurer. During this time, you may not receive coverage even with a valid prescription. Some plans require extensive documentation including lab work, weight history, and proof of participation in supervised weight management programs before approving GLP-1 coverage.