GLP-1 Prior Authorization Checklist: What Your Doctor Needs to Submit
Nearly every insurance plan that covers GLP-1 medications requires prior authorization. Missing even one piece of documentation can result in a denial — not because you don't qualify, but because the submission was incomplete.
Print this checklist and bring it to your next appointment.
The Complete Prior Authorization Packet
Patient Information
- Full name, date of birth, insurance member ID
- Prescribing physician NPI number
- Pharmacy name and NCPDP number
Clinical Documentation (Required)
- Two BMI measurements from different dates, at least 30 days apart
- Diagnosis codes: E66.01 (morbid obesity), E66.09 (other obesity), E66.3 (overweight), or E11.xx (type 2 diabetes)
- Comorbidity documentation (for BMI 27–29.9): lab results showing hypertension, dyslipidemia, prediabetes (A1C 5.7–6.4%), T2D, PCOS, or obstructive sleep apnea
- Failed lifestyle intervention: 3–6 months of documented diet and exercise attempts — nutritionist records, gym membership, food journals, or structured program enrollment
Step Therapy (If Required by Plan)
- Documentation of previous weight-loss medication trials (phentermine, metformin, orlistat) with dates, doses, and outcome
- Reason for discontinuation or inadequate response
Letter of Medical Necessity
- On prescriber letterhead
- Specific clinical rationale for GLP-1 therapy
- Why the requested medication is preferred over alternatives
- Expected treatment duration and follow-up plan
Key Takeaway: The most common PA denial reason is incomplete documentation — not ineligibility. A five-minute review of this checklist before submission can save weeks of back-and-forth.
Tips From Prescribers
- Submit electronically when possible — phone PAs have higher error rates
- Include the medication's NDC number, not just the drug name
- Pre-populate the insurer's specific PA form (available on their provider portal)
- If the patient has T2D, consider submitting under the diabetes indication first
- Save a copy of everything submitted — you'll need it for the appeal
Skip Prior Authorization Entirely
Cash-pay telehealth platforms don't require insurance prior authorization. You see a provider, get evaluated, and receive your prescription — typically within 48–72 hours.