How to Appeal Insurance Denial for GLP-1 Medications

Updated March 2026

Good news: Appeals for GLP-1 denials succeed 30–50% of the time. It's worth the effort — especially if your doctor supports the request.

Step 1: Understand Why You Were Denied

The most common denial reasons:

Step 2: Get Your Doctor Involved

Your doctor needs to submit a Letter of Medical Necessity. This should include:

Step 3: File a Formal Appeal

  1. Call your insurance company and request the formal appeals process
  2. Ask for the denial reason in writing (they're required to provide this)
  3. Submit your appeal within the deadline — usually 30–180 days
  4. Include: denial letter, Letter of Medical Necessity, your medical records, and any peer-reviewed research supporting the treatment
  5. Request an expedited appeal if medically urgent

Sample Appeal Letter Template

[Your Name] | [Date]
[Insurance Company Name]
RE: Appeal of Denial — [Drug Name], Claim #[XXXXX]


To Whom It May Concern:


I am writing to formally appeal the denial of coverage for [Drug Name] prescribed by [Doctor Name, MD] on [Date].


I have been diagnosed with [diagnosis — e.g., obesity with BMI of XX, Type 2 Diabetes, PCOS]. My physician has determined that [Drug Name] is medically necessary for my condition based on [brief clinical rationale]. I have previously tried [list prior treatments] without adequate results.


Enclosed please find: (1) Letter of Medical Necessity from my physician; (2) Relevant medical records; (3) Supporting clinical guidelines from [ADA/AACE/etc.].


I respectfully request that you reconsider this denial and approve coverage for [Drug Name]. Please respond within [X days per your appeals policy].


Sincerely,
[Your Name]
[Contact Information]
[Member ID]

If Your Appeal Is Denied Again