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:

• Documentation of a body mass index (BMI) meeting eligibility criteria (usually BMI = 30, or = 27 with weight-related health conditions such as hypertension, sleep apnea, or high cholesterol). PLUS
• PROOF of participation in a structured diet and exercise program for at least 6 months.
• Evidence that lifestyle changes alone have not resulted in sufficient weight loss.

For the 6-month lifestyle requirement, you must provide verifiable documentation. This may include:

• Receipts or membership records from programs such as Weight Watchers, Noom, or similar structured plans.
• Records from a medically supervised weight loss program.
• Documentation from a registered dietitian or nutritionist.
• Exercise logs or gym membership records (if part of a structured plan).

Please note that self-reported efforts without documentation are not accepted by insurance companies.

In addition, some plans may require:

• Recent office visit notes documenting weight history and counseling on diet and exercise.
• Lab work or additional medical records.
• Trial and failure of other weight management interventions.

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.