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Continued authorization: Many states require evidence of ongoing weight loss (typically 5% or more body weight loss within 12 to 16 weeks) to continue coverage Tips for Successful Prior Authorization Document BMI, comorbidities, and lifestyle counseling at every patient visit, not just the visit where you submit the PA Include specific, detailed language about failed interventions in your clinical notes Submit the PA with complete documentation on the first attempt to avoid delays from requests for additional information Use peer-reviewed clinical trial data (STEP, SURMOUNT) to support your letter of medical necessity Track PA timelines and follow up proactively rather than waiting for automatic denial at the deadline How to Appeal a Medicaid Denial for Weight Loss Medication When Medicaid does not cover weight loss shots on the first attempt, an appeal is often warranted and frequently successful

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It is intended for long-term, ongoing use to help regulate appetite and support sustainable lifestyle changes, rather than providing short bursts of appetite control