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Prior authorization

Prior authorization (PA) is a requirement from your health insurer that your prescriber justify a medication before the plan will cover it. For GLP-1 drugs — expensive and in high demand — it’s one of the most common reasons a prescription stalls at the pharmacy.

What insurers typically ask for

PA criteria vary by plan, but for GLP-1s they often include some mix of:

  • A qualifying diagnosis (type 2 diabetes for Ozempic/Mounjaro; a BMI threshold, often ≥30, or ≥27 with a weight-related condition, for Wegovy/Zepbound).
  • Documentation of prior attempts — sometimes a documented history of diet/exercise efforts, sometimes trying a cheaper drug first (“step therapy”).
  • Your prescriber submitting the request with supporting records.

Why it matters to you

A PA is a paperwork gate, not a final “no.” Prescriptions frequently get approved once the right documentation is submitted — and denied ones can often be appealed successfully. What helps:

  • A prescriber’s office that knows the drill — they submit these constantly.
  • Documentation you can supply: weight history, related conditions, previous weight-loss attempts. This is one place a tracking record genuinely helps — a clear history of your weight and treatment is exactly the kind of evidence that supports a PA or appeal.
  • Persistence. Denials are appealable, and appeals often win.

If insurance won’t cover it or the PA fails, a manufacturer savings card may reduce the out-of-pocket cost, and coverage often hinges on whether the prescription is considered off-label.