aevans@irongatefamilypractice.com
Denise Stockwell, LMHC
Behavioral Health Care Manager
Licensed mental health counselor with over 10 years of experience providing compassionate, evidence-based mental health care. Denise works collaboratively with patients and primary care providers to support emotional well-being and improve overall health.
Dear Patients,
Our office has been inundated with requests for GLP-1s. Self pay for these meds is an option but if you are requesting a GLP-1 medication for weight management and do not have a diagnosis of diabetes, most insurance plans require VERY specific documentation before approving coverage. Prior authorization is not guaranteed and depends on meeting STRICT criteria.
Typically, insurance companies require the following:
For the 6-month lifestyle requirement, you must provide verifiable documentation. This may include:
Please note that self-reported efforts without documentation are not accepted by insurance companies.
In addition, some plans may require:
Once all required documentation is submitted, the prior authorization review process may take several weeks, and approval is not guaranteed.
If you are interested in pursuing this medication, please gather the necessary documentation that you have for the past 6 months and contact our office for a visit so we can assist with the submission process. Without the documentation, receipts for gym memberships, weight watchers etc, we will not submit for prior authorization since it will be denied by your insurance.