Prior Authorization

Prior authorization (PA) is a process used by health insurance plans to determine whether they will cover a prescribed medication, procedure, or service before it is provided. For weight-loss medications including FDA-approved GLP-1 drugs (Wegovy, Zepbound), most commercial insurance plans require prior authorization — and many plans explicitly exclude weight-loss indications from coverage entirely. Even when PA is granted, plans often require step therapy (trying cheaper medications first), evidence of lifestyle-modification attempts, or a documented BMI ≥30 (or ≥27 with comorbidity). Approval rates for GLP-1 weight-loss PA requests vary widely by plan but historically have been low. PA processing typically takes 2–10 business days, and denials can be appealed. AvataCore does not bill insurance — our flat cash-pay pricing eliminates the PA process entirely. Patients who prefer to pursue insurance coverage of an FDA-approved branded GLP-1 should work with their primary care provider, who can submit the PA on their behalf.