Prior authorization (PA) is an insurance requirement that a physician obtain plan approval before prescribing certain medications. PA decisions usually depend on diagnosis (T2D vs obesity), prior trials of cheaper therapies (step therapy), and BMI thresholds. PA processing times range from one business day for expedited requests to two weeks for standard; denial rates for GLP-1 weight-loss approvals exceed 30% on first submission.
Also known as
PAprior auth