Why the drug was denied — and whether the denial is winnable.

The coverage rules and appeal levers across the GLP-1 class.

Approved for type 2 diabetes — denials usually turn on PA or step therapy.

Approved for weight management + CV risk — denials hinge on plan exclusion vs. criteria.

Approved for type 2 diabetes — denials are usually PA, step therapy, or off-label use.

Approved for weight management + obstructive sleep apnea — the OSA angle matters.

Approved for weight management (incl. ages 12+) — often gated by step therapy.

Oral semaglutide for type 2 diabetes — denials are usually PA or step therapy.

What parity actually requires — and how to use it in a denial appeal.

Level-of-care and length-of-stay denials — often winnable on the clinical record.

Detox and rehab denials turn on ASAM level of care — and parity.

Autism ABA denials turn on medical necessity, the treatment plan, and hours.

Step-down level-of-care denials — answered with continued-stay criteria.

Visit caps on therapy can be a parity violation, not just a benefit limit.

Medicare widened CGM coverage in 2023 — most denials now turn on two documented facts.

Medicare covers insulin pumps as DME on set criteria — most denials turn on the lab test and the visit cadence.