Write an appeal letter for a GLP-1 denial
Free. Nothing you enter leaves your browser. Checked October 18, 2026.
October 18, 2026 [Plan name] Appeals Department Re: Request for internal appeal of the denial of coverage for Zepbound Member: [Your full name], member ID [Member ID] Reference: [Claim or reference number], denial dated [date on the denial letter] To whom it may concern, I am writing to appeal your decision of [date] to deny coverage of Zepbound, prescribed for me by [your prescriber's name]. Zepbound is approved by the U.S. Food and Drug Administration for chronic weight management in adults with obesity, or with overweight and at least one weight-related condition, which is the purpose for which it has been prescribed to me. I ask you to review the denial against the FDA-approved indication and my medical records, which my prescriber can provide with a letter of medical necessity, and to approve coverage. If you uphold the denial, please send me the specific criteria and clinical policy used to decide it. Under the Affordable Care Act I have the right to an internal appeal and, if this is denied, to an independent external review. Please include information about external review with your decision. Sincerely, [Your full name] Enclosed: the denial letter; a letter of medical necessity from my prescriber; supporting medical records.
The deadlines
- First decision: plans decide a prior authorization within 15 days for a prior authorization, 72 hours if urgent.
- Internal appeal: File within 180 days of the denial. The plan decides within 30 days for a medicine you have not had yet; urgent cases within 4 business days at most.
- External review: If the internal appeal fails, ask in writing for an external review within 4 months. An independent reviewer decides within 45 days (72 hours if urgent), and the insurer must accept the decision. It is free under the federal process, or $25 at most under a state one.
- Medicare Part D: Ask your plan for a redetermination within 65 days. It decides in 7 days, or 72 hours if your prescriber says waiting could harm your health. If it says no, the next step is an Independent Review Entity; the deadline is on your denial notice.
Three things that make an appeal stronger
A letter of medical necessity from your prescriber, written to the plan's own criteria. Dated records: your BMI at the start, each diagnosis, every program and medicine you tried. And the right reason on the prescription: if you have sleep apnea, heart disease, fatty liver or type 2 diabetes, a medicine approved for that is often covered when weight alone is not. The insurance checker lists the questions to ask first.
Questions people ask
How long do I have to appeal a GLP-1 denial?
For work and marketplace plans, 180 days from the denial for an internal appeal, then 4 months from the final denial for an external review. For Medicare Part D, 65 days to ask your plan for a redetermination.
What should a GLP-1 appeal letter include?
The medicine, the FDA-approved use it was prescribed for, your recorded BMI and diagnosed conditions, what you tried before, a request to review against your records, and a request for the criteria if the plan says no again. A letter of medical necessity from your prescriber makes it much stronger.
Is an external review really independent?
Yes. Under the Affordable Care Act an independent reviewer decides, within 45 days or 72 hours if urgent, and the insurer must accept the decision. It is free under the federal process, or $25 at most under a state process.
More free tools
- How to get a GLP-1 in the USYour route from first question to first dose, for your coverage.
- Eligibility checkYour BMI against the criteria the trials, labels and Medicare use.
- Insurance checkerWhat your kind of plan usually covers, and what to ask.
- Cost and budget calculatorEvery way to pay, side by side, for a month and a year.
- Supply and refill plannerWhen your pens run out, when to reorder, and the national supply.
- GLP-1 diet calculatorYour calories, protein and three days of food for your dose.
Sources, checked October 18, 2026
- HealthCare.gov: internal appeals
- HealthCare.gov: external review
- Medicare.gov: drug plan appeals
- Wegovy prescribing information, DailyMed (revised June 2026)
- Zepbound prescribing information, DailyMed (revised August 2026)
- Foundayo prescribing information, DailyMed (revised July 2026)
- FDA: first medication for obstructive sleep apnea (20 December 2024)
General information for people in the United States, not medical, legal or insurance advice. Prices and plan rules change; the source links above are the final word. foodose does not prescribe, sell or dispense medicine, and is not affiliated with Novo Nordisk or Eli Lilly.