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HomeToolsPrior auth letter generator

Free template tool

Prior authorization letter generator

A GLP-1 prior authorization letter must document the diagnosis, BMI, weight-related comorbidities, prior lifestyle and pharmacotherapy attempts, and the requested medication. Fill in patient details below; the payer-ready letter updates live for Wegovy, Zepbound, Ozempic, or Mounjaro. Copy, download, or print and send to your prescriber to sign.

All data stays in your browser·Mirrors standard payer PA letter format·Print to PDF instantly
Patient
Clinical data
Calculated BMI: 32.3 kg/m² — meets BMI ≥30 threshold
Documented comorbidities

Select all that apply. At least one is required for BMI 27–29.9 weight-management PA.

Prior interventions

Prior weight-management medications trialed

Prescriber
Additional notes (optional)

Letter preview

June 3, 2026

[PRESCRIBER NAME]
NPI: [NPI]
Phone: [PHONE] · Fax: [FAX]

To: [PAYER] Prior Authorization Department
Re: Prior Authorization Request — Wegovy (semaglutide 2.4 mg/0.75 mL)

Patient: [PATIENT NAME]
DOB: [DOB]
Member ID: [MEMBER ID]
Plan type: commercial
Primary diagnosis: Obesity / overweight with weight-related comorbidity (ICD-10: E66.9)

Dear Prior Authorization Reviewer,

I am writing to request prior authorization for Wegovy (semaglutide 2.4 mg/0.75 mL) for the above patient. The patient meets FDA-approved eligibility criteria for this medication.

CLINICAL DATA
  Height: 5'6"
  Weight: 200 lbs
  BMI: 32.3 kg/m²

PRIOR INTERVENTIONS
  Patient completed 6 months of structured lifestyle intervention (calorie-restricted diet plus increased physical activity per CDC guidelines) without achieving clinically meaningful weight reduction (≥5% of body weight).

CLINICAL JUSTIFICATION
  The patient's BMI of 32.3 kg/m² exceeds the FDA-approved threshold for Wegovy. Wegovy is FDA-approved for chronic weight management (E66.0, E66.01).
  Untreated, the patient remains at elevated risk for the cardiovascular, metabolic, and end-organ complications associated with their condition. Pharmacologic intervention is medically necessary to achieve clinically meaningful weight reduction and/or glycemic control beyond what lifestyle modification alone has delivered.

SUPPORTING DOCUMENTATION ATTACHED
  1. Recent clinical notes documenting weight history, lifestyle intervention, and treatment goals
  2. Most recent laboratory results (CBC, CMP, lipid panel, A1C, TSH as applicable)
  3. Records of prior medication trials and outcomes
  4. Patient-signed informed consent acknowledging treatment plan

Please approve this prior authorization request. I am available to discuss this case at the contact information above and can provide additional documentation on request.

Sincerely,


______________________________________________
[PRESCRIBER NAME]
NPI: [NPI]

Letter is a starting draft. Your prescriber must review, edit, and sign before submission. Data stays in your browser — nothing is sent to our server.

How to use this tool

  1. 1

    Fill in patient and clinical data

    Patient name, DOB, insurance carrier, primary diagnosis, height/weight, A1C if applicable, and documented comorbidities. The BMI calculation updates live and flags whether your numbers meet the FDA threshold for weight-management GLP-1s.

  2. 2

    Document prior interventions

    Most payers require 6+ months of structured lifestyle intervention. Select any prior weight-management medications trialed (metformin, phentermine, Contrave, Qsymia). Empty interventions weaken the medical-necessity argument.

  3. 3

    Add prescriber details

    Prescriber name, NPI, phone, and fax appear in the letter header so the payer can route follow-up questions correctly. Leave blank to print bracketed placeholders your prescriber fills in by hand.

  4. 4

    Review the live preview

    The right panel shows the draft letter updating in real time. Edit form fields to refine; the letter regenerates instantly. Click Copy to clipboard, Download .txt, or Print to PDF when ready.

  5. 5

    Send to your prescriber

    The letter must be submitted by the prescriber, not the patient. Forward it via patient portal, email, or print and bring to your next visit. Most prescribers will edit and finalize within 1–3 business days.

Documentation payers usually request

  • • Most recent BMI calculation
  • • A1C, fasting glucose, or other diabetes labs (if applicable)
  • • 6+ months of structured diet and exercise records
  • • Prior medication trial outcomes
  • • Confirmed weight-related comorbidity diagnosis
  • • Cardiovascular risk assessment (for CV-indication PAs)

Common denial reasons

  • • BMI below 27 (hard exclusion for most weight plans)
  • • BMI 27–29.9 without documented comorbidity
  • • Insufficient lifestyle-intervention documentation
  • • Step-through requirements not met (metformin first for T2D)
  • • Off-label use (Ozempic for weight loss without diabetes)
  • • Missing prescriber NPI or contact information

Important — read before using this tool

  • Draft only. The generated letter is a starting point. Your prescriber must review, edit clinical details, and sign before submission. Payers reject letters that contain inaccurate or unverifiable claims.
  • No PHI transmitted. All form data stays in your browser. Closing the tab discards everything. We do not collect, log, or store any field values.
  • Payer-specific formats vary. Some plans require their own PA form rather than a letter. Check with the payer's portal or call member services to confirm submission format.
  • Not a guarantee of approval. Even a well-documented PA can be denied. Plan for an appeals process if the first submission is rejected.

Frequently asked questions

What is a prior authorization for GLP-1 medications?

Prior authorization (PA) is an approval step insurance plans require before covering certain medications. For GLP-1 weight-management drugs (Wegovy, Zepbound), nearly every commercial plan and Medicare Part D requires PA with documentation of BMI ≥30 (or ≥27 with a weight-related comorbidity), 6+ months of lifestyle intervention, and clinical justification for the prescription.

Can I submit this letter to my insurance directly?

No — prior auth letters must be submitted by the prescriber on their letterhead, not by the patient. Use this generator to produce a draft, then send it to your prescriber to review, edit, sign, and submit through the standard PA channels (fax, payer portal, or CoverMyMeds).

Does this tool store my information?

No. All data is processed in your browser. We do not POST to our servers, set cookies, or log any form values. The letter is generated locally; only the .txt download leaves your device when you trigger it.

How long does prior authorization take to approve?

Commercial plans typically respond in 1–7 business days. Medicare Part D approvals often take longer (up to 14 days for standard, 24 hours for expedited). Approvals last 6–12 months and require renewal with updated weight and adherence data.