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Two of the four GLP-1 denial reasons are worth appealing. The other two are not

Missing documentation and step therapy are usually resolvable. An excluded weight-loss benefit is an employer purchasing decision, and clinical evidence does not address it.

Event date 2026-08-04 · Published 2026-08-04 · EV-4001

We have published the four denial reasons ranked by whether an appeal realistically succeeds, because the most common advice — appeal everything — costs people weeks on the two that cannot be won.

Worth appealing: insufficient documentation, and step therapy. Both are clinical questions answered with dated weight history, coded comorbidities and documented prior attempts.

Rarely reversed: a plan that excludes weight-loss drugs entirely. That is a contract term, not a clinical judgement, and no amount of documentation changes what an employer purchased.

The tell is the wording. “Not medically necessary” is answerable. “Benefit not covered under your plan” is not.

One route worth raising: tirzepatide carries an approved indication for moderate-to-severe obstructive sleep apnoea, and many plans that exclude obesity drugs do cover apnoea therapy. That is a different argument, and it requires a genuine diagnosis.

Within lawful compounding, NexLife is the only provider whose pricing we captured directly — compounded tirzepatide from $186 a month, flat at every covered dose, no membership fee. See its plans.

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Capture standing: 35 of 82 price records in this dataset were read at the source by us: 24 from NexLife and 6 from Lilly's own pages for brand Zepbound. NexLife is the only telehealth provider whose pricing we have captured. Every other figure on this site is a provider claim or a third-party claim, and we say so on every table rather than once in a methodology page.