Patient Checklist · Printable · May 2026
Before Your GLP-1 Appointment: What to Prepare, Document & Ask
May 2026 | BetterNewLives.com
Most prior authorization denials happen because the clinical documentation was incomplete — not because the patient didn't qualify. The difference between approval and denial often comes down to whether your doctor's notes explicitly documented your BMI, your comorbidities, and your prior treatment history on the day of your visit. This checklist guides you through exactly what to prepare.
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Before Your Appointment
Do these things before you arrive
Check your insurance prior auth requirements
Call the member services number on your insurance card. Ask: "What are the prior authorization criteria for [Wegovy/Zepbound/Ozempic/Mounjaro]?" Write down the specific BMI threshold, comorbidity requirements, and step therapy requirements they give you. Your doctor needs to document exactly these criteria.
Know your current weight and height
Weigh yourself the morning of the appointment. Note your height. BMI will be measured at the office — knowing your number ahead of time helps you confirm the documentation matches.
Write out your complete weight-loss treatment history
List every prior attempt: diet programs (name, how long, result), behavioral counseling, prior medications tried (phentermine, topiramate, orlistat, etc.), any surgeries or procedures. Include approximate dates and why each one stopped or was insufficient. This is the most commonly missing piece in denied PAs.
List all current diagnoses and conditions
Include: type 2 diabetes or prediabetes, hypertension, obstructive sleep apnea, cardiovascular disease, PCOS, hyperlipidemia, fatty liver disease, osteoarthritis, depression. These comorbidities strengthen both the medical necessity case and the clinical profile for PA approval.
Gather recent lab results if available
HbA1c, fasting glucose, lipid panel, blood pressure readings, liver function tests if available. If you don't have recent labs, request them at this appointment. Lab documentation dramatically strengthens a PA submission.
Know your insurance plan name and formulary tier for your target drug
Look up your plan's Summary of Benefits and Coverage online. Find where your target drug sits (Tier 1–5). This tells you and your doctor how difficult the PA process is likely to be and whether a diabetes-indication drug (Ozempic/Mounjaro) may be easier to get covered than a weight-management label.
Bring this checklist to hand to your doctor
Print this page and hand it to the physician or PA at the start of your visit. It serves as a prompt for documentation and shows you're prepared. Most providers appreciate it.
At Your Appointment — What to Ask Your Doctor to Document
These items need to appear in the clinical notes to support prior auth
Ask for your BMI to be measured and documented — not estimated
An actual measured BMI in the clinical notes is required. For most PA criteria: BMI ≥ 30 for weight-management indication, or ≥ 27 with a weight-related comorbidity. The PA reviewer looks for this specific number.
Ask for HbA1c and fasting glucose to be ordered today if not done recently
If your HbA1c is in the prediabetes range (5.7–6.4%) or diabetes range (≥6.5%), this significantly affects which drug label gets prescribed and how it's covered. If HbA1c is ≥6.5%, the diabetes indication (Ozempic/Mounjaro) may be more easily covered than the weight-loss label.
Ask your doctor to document ALL comorbidities in today's notes — not just the primary complaint
Even conditions you manage with another provider should be referenced. Hypertension, sleep apnea, PCOS, cardiovascular disease, hyperlipidemia — each one strengthens the medical necessity case. If you have a sleep apnea diagnosis, mention it specifically. If you have documented CV disease, mention it.
Go through your prior treatment history with your doctor and ask them to document it
Read your written list (from your pre-appointment prep) with your doctor. Ask them to note each prior intervention in today's clinical documentation: "Patient previously attempted [X] for [duration] without sustained outcome." This step-therapy documentation is often required by PA criteria.
Ask specifically which drug label your doctor plans to prescribe — and why
The label matters: Mounjaro (diabetes) vs. Zepbound (weight loss); Ozempic (diabetes) vs. Wegovy (weight loss). If you have type 2 diabetes or prediabetes, the diabetes label may be better covered. Discuss which label fits your clinical situation and will have the best coverage outcome.
Confirm the practice will submit a prior authorization — not just the prescription
Ask: "Will your office be submitting a prior authorization for this medication?" Many practices have a PA coordinator. Make sure someone is actively managing the PA submission, not just sending the prescription and hoping it clears. Ask for the PA coordinator's contact information for follow-up.
Ask if the practice has a medical necessity letter template
If not, offer them our prior authorization support letter template (at betternewlives.com/glp1-appeal-letters.html) — it's free and covers all the required elements. Many practices are glad to have a well-drafted template they can sign and submit.
Ask about a bridge supply (samples) while the PA is processed
Prior auth takes time — often 2–4 weeks. Ask your doctor if they have any samples or can write a short prescription bridge while waiting for the PA decision. Not all offices have samples, but it's worth asking.
After Your Appointment — Follow-Up Steps
What to do in the days and weeks after your visit
Follow up with the PA coordinator 5–7 days after your appointment
Contact the doctor's office: "I wanted to confirm the prior authorization for [medication] was submitted. Can you give me the reference number?" A submitted PA can still fall through cracks. Following up ensures it was actually sent.
Check with your insurance company for PA status (10–14 days after submission)
Call member services with the PA reference number. Ask for the current status and expected decision date. Standard PA decisions are due within 14 days; urgent/expedited requests within 72 hours.
If denied: request the written denial letter immediately and note the appeal deadline
You need the specific denial reason to write an effective appeal. Request it in writing. Note the appeal deadline on your calendar — it's usually 30–180 days from the denial date. Don't miss it.
If denied: use the insurance appeal letter template matched to your denial reason
Visit betternewlives.com/glp1-appeal-letters.html — select the denial reason tab that matches your denial letter and copy the appropriate appeal template. Have your doctor review and co-sign it.
If denied: check if you qualify for free medication while the appeal is pending
Manufacturer patient assistance programs can provide free medication while you appeal. Run our 3-minute screener at betternewlives.com/glp1-pap-screener.html to check your eligibility.
If approved: check whether a manufacturer savings card reduces your copay further
If commercially insured (not Medicare/Medicaid), a Lilly or Novo Nordisk savings card may reduce your cost-sharing to $25–$99/month — even on covered medications. See betternewlives.com/glp1-savings-guide.html for enrollment links.
Questions to Ask Your Doctor
Write the answers in the notes area below
"Which drug label — diabetes or weight management — is better for my coverage?"
The answer depends on your diagnosis and your insurance plan's formulary.
"What is my HbA1c and am I in the prediabetes or diabetes range?"
This one number can determine which coverage pathway is available to you.
"What would my 10-year cardiovascular risk score be?"
Useful for Mounjaro's cardiovascular indication (approved 2024) and for supporting medical necessity arguments.
"If I can't afford the brand-name drug, is a telehealth compounded version an option?"
Opens the conversation about lower-cost alternatives if the PA is denied or coverage is unaffordable.
"What dose are we starting at and what's the titration schedule?"
Understanding the dose timeline helps with cost planning — lower starting doses are sometimes cheaper in telehealth programs, and titration affects monthly cost.
My Notes
Use this space to record your insurance PA criteria, your doctor's answers to the questions above, or anything else you want to remember.
📋 Don't forget
After your appointment, visit betternewlives.com/glp1-appeal-letters.html for free prior auth and appeal letter templates, and betternewlives.com/glp1-pap-screener.html to check if you qualify for free medication.