Your medication was denied. We fight it.
GLP-1s, biologics, migraine and asthma therapies. Each drug is denied for different reasons and won on different evidence. Find yours below, then start your appeal with $0 upfront.
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GLP-1
Zepbound (tirzepatide)
A Zepbound denial is the start of a process, not the end. Most are overturned when the appeal quotes the plan's own criteria and frames the request around an approvable indication. Coding it as obstructive sleep apnea, rather than weight loss, is often the difference.
Wegovy (semaglutide)
Wegovy and other GLP-1 weight-loss drugs are among the most frequently denied prescriptions, usually because insurers treat them as lifestyle drugs. But Wegovy also carries indications beyond weight management, including cardiovascular risk reduction in eligible patients, which can turn a denial into an approval.
Ozempic (semaglutide)
Ozempic is FDA-approved for type 2 diabetes, so denials usually hinge on prior-authorization details rather than a flat exclusion. That makes them highly appealable when the diagnosis, prior therapies, and rationale are documented to the plan's criteria.
Mounjaro (tirzepatide)
Mounjaro is FDA-approved for type 2 diabetes. Like Ozempic, most denials are prior-authorization issues rather than exclusions, so a well-documented diabetes medical-necessity appeal frequently succeeds.
Autoimmune
Cosentyx (secukinumab)
Cosentyx denials usually come down to step therapy or undocumented criteria, not a true exclusion. A specialist-supported medical-necessity appeal that documents prior failures is the path to approval.
Dupixent (dupilumab)
Dupixent denials typically require proof that standard therapy was tried and the condition is severe enough to qualify. A documented, specialist-supported appeal overturns most.
Humira (adalimumab)
With biosimilars now common, Humira denials often involve a biosimilar-first requirement. A specialist letter documenting why the specific therapy is necessary is the key to approval.
Skyrizi (risankizumab)
Skyrizi denials usually turn on a biologic step-therapy requirement or undocumented severity. A specialist-supported appeal that documents prior failures resolves most.
Rinvoq (upadacitinib)
Rinvoq sits behind step-therapy rules tied to its drug class, often requiring a prior TNF inhibitor. A documented failure or intolerance of required alternatives is the path to approval.
Tremfya (guselkumab)
Tremfya denials usually involve a biologic step-therapy requirement or undocumented severity. A specialist-supported appeal documenting prior failures overturns most.
Stelara (ustekinumab)
Stelara denials usually involve a biosimilar-first or step-therapy requirement, or undocumented severity. A specialist-supported appeal documenting prior failures overturns most.
Entyvio (vedolizumab)
Entyvio denials for inflammatory bowel disease usually require documented failure of conventional therapy or a prior biologic. A GI-specialist-supported appeal overturns most.
Otezla (apremilast)
Otezla denials usually require documented failure of topical or conventional therapy first. A documented, specialist-supported appeal overturns most.
Taltz (ixekizumab)
Taltz denials usually involve a biologic step-therapy requirement or undocumented severity. A specialist-supported appeal documenting prior failures overturns most.
Migraine
Nurtec (rimegepant)
Nurtec denials usually require proof that triptans or preventives were tried first, or documentation of migraine frequency. A documented, specialist-supported appeal overturns most.
Ajovy (fremanezumab)
Ajovy denials usually require documented failure of oral preventives first, plus migraine frequency. A documented appeal overturns most.
Ubrelvy (ubrogepant)
Ubrelvy denials usually require proof that triptans were tried or are contraindicated. A documented appeal overturns most.
Emgality (galcanezumab)
Emgality denials usually require documented failure of oral preventives first, plus migraine frequency. A documented, neurology-supported appeal overturns most.
Asthma
Xolair (omalizumab)
Xolair denials usually require documented failure of standard controllers and supporting IgE or diagnosis data. A specialist-supported appeal overturns most.
Tezspire (tezepelumab)
Tezspire denials for severe asthma usually require documented exacerbation history and prior controller or biologic therapy. A specialist-supported appeal overturns most.
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