Published August 27, 2026 · updated August 27, 2026

GLP-1 prior authorisation: which providers help and what they charge

What a prior authorisation for Zepbound or Wegovy involves, the documentation plans ask for, typical reasons for denial and appeal, and how telehealth providers differ in handling it.

What it is

Prior authorisation is the plan’s review of a prescription against its coverage criteria before it agrees to pay. For GLP-1s used for weight management the criteria commonly include a documented BMI threshold (30, or 27 with a weight-related condition), a diagnosis code, sometimes a documented lifestyle programme of several months, and sometimes step therapy through other medications. For the cardiovascular or sleep-apnoea indications, the criteria are diagnosis-specific.

What the provider submits

Height, weight and BMI from the visit; the diagnosis; relevant history; prior attempts; and the clinical rationale. Incomplete submissions are the most common cause of avoidable denial.

How providers differ

• Whether they submit prior authorisations at all, or leave it to the patient’s pharmacy.
• Whether they charge for it, as a separate fee or within a membership.
• Whether they handle appeals.
• How quickly they respond to plan requests for more information.

The provider profile records the prior-authorisation support field once verified from the provider’s pages; until then it is unknown.

Denials and appeals

A denial states the criterion not met. Appeals succeed most often when the missing documentation is supplied or when the plan has misread the record. If the plan excludes weight-management drugs entirely, appeals rarely succeed and the cash routes apply.

Related: /guides/glp1-telehealth-that-accepts-insurance/ /guides/zepbound-telehealth-with-insurance/ /guides/wegovy-telehealth-with-insurance/

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