When a breakthrough medication promises hope and renewed health, only to be blocked by an insurance denial, the blow is deeply personal. That’s what too many Californians experience today as GLP‑1 obesity drugs—expensive, life‑changing medications—are increasingly denied despite their proven benefits. At The Law Offices of Scott Glovsky, we understand that when your health, dignity, and future are on the line, insurance companies shouldn't stand between you and the care you need. That’s why we fight—hard and with heart.
Why GLP‑1 Coverage Is Getting Harder to Secure
First, GLP‑1 medications—like semaglutide (Ozempic / Wegovy), tirzepatide (Zepbound / Mounjaro), liraglutide (Saxenda), Retatrutide, and others—revolutionize obesity treatment. But with prices stretching into the thousands per month, many insurance companies don’t want to cover them. What does that mean for you?
1. Narrowing “Medically Necessary” Definitions
Insurers may argue that weight loss treatments are elective rather than essential. Even if obesity heightens your risks for diabetes, heart disease, or joint injury, plans may still label GLP‑1s as not medically necessary.
2. Emerging Prior Authorization Hurdles
Many plans add pre‑approval steps. You may be asked to jump through hoops, such as going on doctor-supervised weight loss programs, providing a detailed history of failed weight‑loss efforts, documentation from multiple specialists, or proof of other interventions such as nutritionists. Any of these steps can lead to insurance claim denials.
3. Administrative Delays and Policy Loopholes
Some insurers delay, hiding behind technicalities such as dates, forms, or network-level mismatches. For example, mail-order pharmacy rules, step therapy requirements, or obscure formulary changes can derail an otherwise valid claim.
4. No Room for Change
Once denied, insurers often shift the burden to you. You’re left appealing, re‑filing, and advocating—while your health suffers. The power dynamic feels unfair and overwhelming.
What You Can Do—And How We Can Help
1. Obtain a Detailed Letter of Medical Necessity
Your provider’s letter must tie GLP‑1 medication to real, documented medical risks and interventions you’ve already tried. The more precise and emotionally compelling, the better. In addition, some of the GLP-1 medications have been FDA-approved for other conditions that you may suffer from. For example, Wegovy has been approved for certain individuals with heart disease and MASH (Metabolic Dysfunction-Associated Steatohepatitis). Wegovy’s main ingredient is also prescribed to people with Type 2 diabetes, in a product called Ozempic.
2. Track Every Step of the Process
Document dates of submission, communications, and responses. Hold your insurer to its deadlines—California law requires acknowledgment within 15 days and a decision within 40 days. Missed timelines may bolster your case.
3. File a Strong, Document‑Rich Appeal
When insurance companies wrongly deny—especially when definitions of necessity are being stretched—you have the right to dispute. Appeals should reference your medical record, the provider’s expert opinion, and the plan’s stated language. Your doctor can also submit a Prescription Drug Prior Authorization or Step Therapy Exception Request form as outlined on this page.
4. Get a Legal Advocate in Your Corner
This is where we step in. We bring decades of experience taking on insurers who refuse to do what’s right. With personalized attention, we can analyze your policy, uncover bad‑faith tactics, and build a compelling case to fight the denial—including negotiation or litigation.
Los Angeles Prescription Denial Lawyer
At The Law Offices of Scott Glovsky, we know how isolating and unjust it feels when insurers deny your access to critical care. We don't shrink from the fight. We’re relentless—and deeply human. If your claim for a GLP‑1 obesity medication was denied call us today at (626) 323-8351 for a free case evaluation. We’ll stand with you, guiding every step of the journey to the coverage and justice you deserve.