GLP-1 Prior Authorization Letter Generator

What prior authorization is and why GLP-1s need it

Prior authorization (PA) is a utilization management rule insurers use to control spending on high-cost drugs. For brand GLP-1 weight-loss medications — Wegovy, Zepbound, Saxenda, and the newly approved Foundayo — virtually every US commercial plan requires PA before paying any portion of the prescription. The reason is simple: list prices are $999 to $1,349 per month, and a covered patient on therapy for a year represents $12,000 to $16,000 of annual plan spend.

A complete PA submission has to demonstrate three things: (1) the patient meets the FDA-label eligibility criteria (BMI ≥ 30 kg/m², or BMI ≥ 27 kg/m² with at least one weight-related comorbidity), (2) prior weight management attempts have been documented to satisfy the plan's step-therapy requirement, and (3) the prescribing clinician attests to the clinical rationale and ongoing monitoring plan. The letter generated by this tool covers all three and uses FDA-label language verbatim where possible.

How to use the generator

1. Pick your insurer from the dropdown.
2. Pick the drug and dose your clinician is prescribing.
3. Enter your weight and height — BMI auto-computes.
4. Check off any documented comorbidities.
5. Check off documented prior weight loss attempts (the step-therapy requirement most plans enforce).
6. Copy the letter and bring it to your prescribing clinician. They will review, edit, sign, and submit it through the insurer's pharmacy benefit portal.

Nothing you enter is stored or transmitted — the letter is assembled in your browser only. We do not log patient information.

Sample PA letter (Wegovy + BMI 32 + Type 2 diabetes + Aetna)

Below is a fully rendered sample of what the generator produces for the most common case: a patient requesting Wegovy 2.4 mg, BMI 32, with documented Type 2 diabetes, covered by Aetna. The live generator above customizes this for every drug, insurer, and comorbidity combination.

April 8, 2026

Aetna Pharmacy Prior Authorization Department
Re: Prior Authorization Request

Patient: [Patient Name]
Date of Birth: [MM/DD/YYYY]
Height: 5 ft 8 in
Current Weight: 210 lbs
BMI: 32.0 kg/m²
Requested Medication: Wegovy (semaglutide) 2.4 mg subcutaneous once weekly
Requested Quantity: four (4) single-dose 2.4 mg pens per 28 days

To Whom It May Concern,

I am writing to request prior authorization coverage of Wegovy (semaglutide) 2.4 mg subcutaneous once weekly for the above-named patient for the FDA-approved indication of chronic weight management.

FDA-Approved Indication. Wegovy (semaglutide) is FDA-approved as an adjunct to a reduced-calorie diet and increased physical activity for chronic weight management in adults with obesity (initial BMI ≥ 30 kg/m²) or overweight (BMI ≥ 27 kg/m²) in the presence of at least one weight-related comorbid condition.

Patient Eligibility. The patient's documented BMI of 32.0 kg/m² meets the FDA-label criterion of BMI ≥ 30 kg/m² (obesity). The patient additionally carries the following documented weight-related comorbid condition(s): Type 2 diabetes mellitus (ICD-10 E11.9).

Clinical Rationale. Wegovy is supported by Level 1 evidence from the STEP-1 pivotal trial. STEP-1 (Wilding et al., NEJM 2021) demonstrated mean total body weight loss of 14.9% over 68 weeks at the 2.4 mg maintenance dose. The combination of the patient's BMI and documented comorbid burden places them squarely within the FDA-approved population studied in the pivotal trial, and the requested dose is the labeled maintenance dose.

Step Therapy and Prior Treatment History. Prior to this request, the patient has documented the following weight management attempts, none of which produced clinically meaningful or sustained weight loss: supervised reduced-calorie dietary intervention of at least 6 months duration, structured physical activity program of at least 150 minutes per week sustained for 6 months, and prior trial of phentermine, discontinued for inadequate response or intolerance. These attempts satisfy the step-therapy documentation requirement.

Plan-Specific Note. Per Aetna's published Clinical Policy Bulletin for anti-obesity medications, the patient meets the BMI threshold and has documented prior weight management attempts as required for step-therapy compliance.

Attestation. The patient meets the FDA-approved indication and the plan's documented coverage criteria. I attest that the information above is accurate to the best of my knowledge, that I have personally evaluated this patient, that I will continue to monitor weight, vital signs, and adverse effects per standard of care, and that I will discontinue therapy if the patient does not achieve at least 5% total body weight loss after a clinically appropriate trial period at the maintenance dose, consistent with the FDA label discontinuation criterion.

Requested Action. Please approve coverage of Wegovy 2.4 mg subcutaneous once weekly for an initial 6-month supply, with reauthorization based on documented weight-loss response.

Thank you for your prompt review. Please contact my office with any questions or to request additional documentation.

Sincerely,

[Prescribing Clinician Name, MD]
Prescribing Clinician
_________________________________
Signature                                    Date

DRAFT — Review with prescribing clinician before submission. Not legal or medical advice.

Frequently asked questions

What is prior authorization for GLP-1 drugs?

Prior authorization is a coverage rule that requires your doctor to submit clinical documentation to your insurer before the plan will pay for a brand GLP-1 like Wegovy or Zepbound. It is the single biggest friction point in getting brand GLP-1 weight-loss drugs approved.

Why do insurers require prior auth for Wegovy and Zepbound?

Brand GLP-1s cost $1,000 to $1,400 per month at list price. Insurers require PA to confirm the patient meets the FDA label criteria, has tried lower-cost weight management interventions first, and has a documented clinical rationale for therapy. See our GLP-1 insurance coverage audit for the actual coverage rates by plan.

How long does prior authorization take?

Most commercial plans process a complete PA submission within 3 to 14 business days. Standard turnaround is about 5 business days; expedited reviews are typically 24 to 72 hours. Incomplete submissions add 1 to 2 weeks of back-and-forth — which is exactly the friction this tool is designed to eliminate.

Will my doctor write the PA letter for me?

Yes — the prescribing clinician is required to author and sign the PA letter; insurers will not accept a letter from the patient. This generator produces a draft template the clinician can review, edit, and sign. See our guide on how to get a GLP-1 prescription.

What if my prior auth is denied?

You have a federally protected right to appeal under the Affordable Care Act. Common denial reasons are missing BMI documentation, missing prior weight-loss attempts, or non-formulary status. A peer-to-peer review (your doctor calls the insurance medical director) overturns roughly 30 to 50 percent of initial denials.

Do I need prior auth for compounded GLP-1?

No. Compounded semaglutide and tirzepatide from a 503A or 503B compounding pharmacy are paid out of pocket and do not run through your insurance pharmacy benefit, so no PA is involved. The trade-off is no insurance coverage and added quality and supply risk.

Can I appeal a denial?

Yes. You can request an internal appeal directly with your insurer and, if denied again, an independent external review. Federal law gives you 180 days from the denial notice to file the internal appeal. Including the original PA letter plus additional clinical documentation strengthens the appeal.

How is the BMI requirement enforced?

Insurers verify BMI from the height and weight documented in the most recent clinical visit note. The BMI must be calculated and recorded in the patient's chart before PA submission, not estimated. Wegovy, Zepbound, Saxenda, and Foundayo all share the same FDA-label threshold: BMI ≥ 30 kg/m², or BMI ≥ 27 kg/m² with a weight-related comorbidity.

Important disclaimer

This tool produces a draft template only. It is not medical advice, legal advice, or a guarantee of insurance coverage. The letter must be reviewed, edited, and signed by the prescribing clinician before submission. The generator uses FDA-label language verbatim where possible and does not invent clinical recommendations. Weight Loss Rankings does not provide medical advice, diagnosis, or treatment recommendations and is not affiliated with any insurer or drug manufacturer.

Related tools and research

• GLP-1 insurance coverage: Medicare, Medicaid, and commercial — what each plan type actually covers
• GLP-1 insurance coverage audit — coverage rates by major commercial plan
• Employer insurance checker — check whether your employer covers GLP-1s
• How to get a GLP-1 prescription — the full clinician workflow
• GLP-1 cost per pound lost calculator — what you actually pay per pound at list price vs covered