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Wegovy Denied by Insurance? How to Appeal (Free Sample Letter)
Why Wegovy coverage gets denied, how a prior authorization or exception appeal works, and a free sample paragraph.
Wegovy (semaglutide) is FDA-approved for chronic weight management and to reduce the risk of major cardiovascular events in certain adults with heart disease and overweight or obesity. Many plans exclude weight-loss drugs entirely, while others cover them with prior authorization criteria such as BMI thresholds and documented lifestyle programs.
Free sample appeal paragraph
I am appealing the denial of coverage for Wegovy [dose] dated [date]. My prescriber, [name], prescribed Wegovy for [FDA-approved indication, e.g. diagnosis and ICD-10 code]. My records document [relevant labs/measurements, e.g. A1c, BMI, comorbidities] and prior treatment with [drugs tried, dates, outcome]. Because I meet the plan's criteria / formulary alternatives are not appropriate for me for the reasons in the enclosed letter, I request that the plan approve coverage.
Replace the [brackets] with your details. This is a starting point, not legal advice.
What to do
- First work out whether it is a plan exclusion or a criteria-not-met denial. Exclusions are much harder to overturn; criteria denials are often fixed with better documentation.
- Ask for the plan's written prior authorization criteria for the drug and address each item.
- List previous medications tried, with dates and why they were stopped.
- If the plan requires step therapy, ask your prescriber about a step therapy exception. Many states have step therapy laws.
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Start the free checkFrequently asked questions
Can I appeal if my plan excludes Wegovy for weight loss?
You can appeal, but if the plan document clearly excludes the drug category, the appeal is less likely to succeed. Some people ask their employer about coverage policy or check whether a different, covered diagnosis applies. Talk with your prescriber.
What documents help a Wegovy appeal?
The prescriber's letter of medical necessity, diagnosis codes, relevant lab values or measurements, chart notes, and a history of prior treatments tried.
How do I appeal a wegovy denial denial?
Start with the instructions and deadline on your denial letter. Gather your medical records and a letter of medical necessity, respond directly to the stated denial reason, and file an internal appeal. Keep proof of submission.
Is external review available?
For many non-grandfathered plans, independent external review may be available for denials involving medical judgment after a final internal denial, generally within 4 months. Confirm on your denial notice.
Related guides
- Appeal a Denied GLP-1 / Weight-Loss Drug Coverage
- Ozempic Denied by Insurance? How to Appeal (Free Sample Letter)
- Mounjaro Denied by Insurance? How to Appeal (Free Sample Letter)
- Zepbound Denied by Insurance? How to Appeal (Free Sample Letter)
- Step Therapy Exception: How to Ask Your Insurer to Skip 'Fail First'
- Biologic Drug Denied (Humira, Dupixent, etc.)? Appeal Guide
- All appeal guides
Document preparation / educational use only. This site is not a law firm, regulator, airline, insurer, or parking operator. Nothing here is legal advice. Outcomes are never guaranteed. Review every letter carefully before sending and consult a licensed professional if you need advice about your situation.