Evidence-graded answer
How do I get prior authorization for Wegovy or Zepbound approved?
Approval rates vary by insurer from 30-70%. The highest-yield steps: documented BMI ≥30 (or ≥27 with a comorbidity), at least one documented diet/exercise attempt, baseline labs (A1c, lipids), prescriber notes citing FDA indication, and same-day appeal of denials with the carrier-specific reason. See /insurance-appeal/[carrier]/[drug] for templates.
Common denial reasons: BMI documentation gaps, missing comorbidity ICD-10 codes, formulary tier issues, requiring step therapy through phentermine first.
Top approval boosters: Z68.30+ codes (BMI bracket), E11.X (T2D) or I10 (HTN) or K76.0 (NAFLD) as comorbidity codes, and a brief narrative about previous lifestyle modification attempts in the prescriber note.
Carrier-specific patterns: Aetna and Cigna often require 6-month lifestyle documentation; UHC and BCBS often require step therapy; Kaiser often denies outright for non-T2D patients but approves with cardiology-CVD documentation.