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How to maximize approval odds: the documentation checklist If you're pursuing insurance coverage for Zepbound through Express Scripts, this checklist maximizes your approval odds: Before the prescriber submits the PA: [ ] Confirm your BMI meets the threshold (over 30, or over 27 with documented comorbidity) within the past 30 days [ ] Obtain documentation of a 12-week structured lifestyle intervention (dietitian visits, weight-loss program enrollment, or detailed clinical notes showing provider-directed diet and exercise counseling) [ ] Confirm you have not filled any other weight-loss medication in the past 90 days (check your pharmacy records) [ ] Confirm you are not currently on any GLP-1 agonist (if switching from compounded semaglutide, stop it and wait 5 weeks before PA submission) [ ] If your plan requires step therapy, confirm you have tried and failed Wegovy (or have a documented contraindication) [ ] Gather documentation of weight-related comorbidities if your BMI is 27 to 30 (hypertension, diabetes, dyslipidemia, sleep apnea, cardiovascular disease) What the prescriber should include in the PA submission: [ ] Baseline BMI with date of measurement [ ] Copy of lifestyle intervention records (program enrollment letter, dietitian notes, or detailed clinical notes) [ ] List of weight-related comorbidities with ICD-10 codes [ ] Statement that patient is not on other weight-loss medications or GLP-1 agonists [ ] If step therapy applies, documentation of Wegovy trial and failure (or contraindication) [ ] Clinical rationale for why Zepbound is medically necessary (specific to the patient, not generic) After submission: [ ] Follow up with Express Scripts within 72 hours to confirm PA was received [ ] If denied, request the specific denial reason in writing [ ] If denied for missing documentation, submit appeal with the missing records within 7 days (faster appeals have higher success rates) [ ] If denied for not meeting criteria, evaluate whether compounded tirzepatide is a better path than appeal The single most common fixable error is incomplete lifestyle intervention documentation