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Approval rates by documentation completeness: Complete documentation on first submission: 68% approval rate Incomplete documentation requiring additional information: 34% approval rate after resubmission Appeals after initial denial: 41% approval rate Average timeline: Prior authorization with complete documentation: 7 to 10 business days Prior authorization requiring additional information: 14 to 21 business days Appeal after denial: 30 to 45 days Most common reasons for denial (in order of frequency): Insufficient documentation of 6-month diet and exercise failure (42% of denials) BMI does not meet threshold or comorbidity not adequately documented (28% of denials) Medication requested is not on approved list (Ozempic for weight loss, compounded medications) (18% of denials) Contraindication present or not adequately ruled out (7% of denials) Plan-specific exclusion (employer opted out of weight loss medication coverage) (5% of denials) The 6-month documentation requirement is the single largest barrier
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