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)
A Dupixent denial is rarely a final answer, it is usually a paperwork gap your plan is daring you to leave unfilled. Because dupilumab is FDA-approved across a spread of type 2 inflammatory conditions, from moderate-to-severe atopic dermatitis and eosinophilic or oral-steroid-dependent asthma to chronic rhinosinusitis with nasal polyps, prurigo nodularis, eosinophilic esophagitis, and COPD with an eosinophilic phenotype, payers lean on indication-specific traps: a topical-corticosteroid or systemic step-therapy requirement in eczema, a documented failure of an inhaled corticosteroid plus controller and an eosinophil count threshold in asthma, or proof of inadequate response to intranasal steroids before polyps. The reversal comes from matching the chart to the exact indication, the correct ICD-10 anchor such as L20.9 for atopic dermatitis or J33.x for nasal polyps, the validated severity measure the label invites (EASI or IGA scores, biologic eosinophil counts, ACQ or exacerbation history), and a clean record of the prior therapies the plan demanded. Build the file around the indication the payer actually disputed, and the medical necessity stops being arguable.
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)
A Tremfya denial almost never means the drug is wrong for you, it usually means the plan wants its paperwork in a different order. Because guselkumab is a selective IL-23p19 blocker, payers routinely demand documented failure or intolerance of a TNF inhibitor and often a cheaper IL-17 agent first, or they question whether your plaque psoriasis truly meets the moderate-to-severe threshold versus mild disease they would rather treat topically. We win these by anchoring the file to the exact indication and ICD-10 (L40.0 for plaque psoriasis, L40.50 to L40.59 for psoriatic arthritis, or K51 for ulcerative colitis), pairing it with a body-surface-area and PASI or IGA score that crosses the severity line, and laying out the dated record of every prior systemic and biologic you actually tried and why it failed or harmed you. When the medical necessity is told as one clean, chronological story, the step-therapy wall stops being a reason to say no.
Stelara (ustekinumab)
A Stelara denial is not a verdict, it is the opening move in a review your plan fully expects you to challenge. Because ustekinumab now competes with a wave of interchangeable biosimilars, most denials hinge on a biosimilar-first or non-medical-switch rule, or on a step-therapy block demanding documented failure of a TNF inhibitor or conventional therapy before this IL-12/23 agent is approved for your moderate-to-severe Crohn's disease, ulcerative colitis, plaque psoriasis, or psoriatic arthritis. The appeals that succeed pin the exact ICD-10 anchor to the labeled indication, attach the objective severity record (a documented Mayo or CDAI score for IBD, BSA or PASI involvement for psoriasis), and supply the dated prior-therapy trail showing intolerance or inadequate response to the comparator the plan named. When a continuation request is at stake, we also show that an established response makes a forced switch a clinical risk, not a cost-neutral substitution. Build the record around those specifics and a reviewer has no clean ground left to stand on.
Entyvio (vedolizumab)
A denial for Entyvio is not the end of your treatment plan, it is simply the point where the documentation has to catch up to your medical history. Because vedolizumab is a gut-selective integrin biologic reserved for moderately to severely active ulcerative colitis or Crohn's disease, plans almost always deny it on step therapy, demanding proof that you failed, lost response to, or could not tolerate a TNF blocker such as infliximab or adalimumab, and they often dispute that your disease activity is severe enough to justify a biologic at all. What turns this denial around is a tight evidentiary record: the correct ICD-10 anchor (K51 for ulcerative colitis or K50 for Crohn's), a documented Mayo or CDAI activity score establishing moderate-to-severe disease, and a dated trial-and-failure or intolerance history for each prior agent the plan expected you to use, all tied to the FDA-labeled population your gastroenterologist is treating. When that chain is assembled correctly, the clinical case for coverage is no longer one the plan can credibly contest. We build that record for you and carry the appeal through every level it takes.
Otezla (apremilast)
A denial on Otezla is not a closed door, it is simply the point where the clinical record has to do the talking. Because apremilast is an oral PDE4 inhibitor rather than an injected biologic, plans most often reject it under step-therapy logic, insisting you first fail methotrexate or a TNF agent, or they question whether your plaque psoriasis truly meets a moderate-to-severe threshold for systemic therapy. What turns this around is the precise picture the plan is asking for: an L40.x diagnosis for plaque psoriasis or psoriatic arthritis (or M35.2 for Behcet's oral ulcers), a documented body-surface-area or PGA severity score, and a clear history of the topical or conventional agents that fell short or were not tolerated. Build that record correctly and Otezla stops looking optional to the reviewer and starts looking medically necessary.
Taltz (ixekizumab)
A Taltz denial is seldom a closed case; it is usually the plan applying a step-therapy or documentation screen that a well-built appeal can clear. As an IL-17A antagonist, ixekizumab is most often blocked when a plan demands a prior TNF inhibitor trial first, questions whether non-radiographic axial spondyloarthritis is truly active, or finds the psoriasis severity record too thin to justify a biologic over topicals. What turns these around is precise: a documented failure, intolerance, or contraindication to the specific agents the plan names (commonly adalimumab or etanercept), paired with the right objective anchor for the indication, an elevated CRP or MRI-confirmed sacroiliitis for axial disease, or a quantified PASI or body-surface-area score with the L40.0 psoriasis code for skin involvement. Map the chart to the exact criterion the plan invoked, and a Taltz denial tends to give way to coverage.
Migraine
Nurtec (rimegepant)
A Nurtec denial almost always reflects a step-therapy rule, not a verdict on whether you need the medication, and that rule is appealable. Plans most often reject rimegepant because they want a documented trial and failure of one or two oral triptans first, or they flag its unusual dual status as both an acute and a preventive therapy and demand you pick one lane, or they cite an existing CGRP-class agent and apply a duplicate-therapy block. What turns this around is a clean record of the specific triptans tried with the reason each was stopped (lack of response, recurrence, or a cardiovascular contraindication that makes triptans unsafe), paired with an ICD-10 anchor of G43 mapped to your true diagnosis and a monthly migraine-day count that frames acute versus preventive use the way your prescriber actually intends it. We build the appeal so the plan can no longer pretend the gepant indication and your trial history are unclear. When the evidence is laid out this precisely, the original rejection rarely survives a second read.
Ajovy (fremanezumab)
A denial on Ajovy is rarely the final word, it is usually a paperwork problem the plan expects you to abandon, and you do not have to. Because Ajovy (fremanezumab) is a CGRP-targeting preventive cleared for the prevention of migraine in adults, most plans bury it behind a step-therapy wall, demanding documented failure or intolerance of two or more older oral preventives across drug classes such as a beta-blocker, an antiepileptic like topiramate, and a tricyclic, and they reject the claim when that prior-treatment trail is missing or incomplete. The denial flips when the appeal anchors a clean migraine diagnosis (ICD-10 G43 series, distinguishing episodic from chronic with monthly migraine and headache-day counts), pairs it with a dated record of each prior preventive tried and why it failed, and ties the request to Ajovy's labeled once-monthly or quarterly dosing so the medical-necessity case matches the product exactly. Done this way, the file stops reading like a request and starts reading like a record the reviewer cannot defensibly turn down.
Ubrelvy (ubrogepant)
An Ubrelvy denial usually turns on a single coverage rule, not on whether you actually need the medicine, and that single rule is easier to satisfy than it looks. Because ubrogepant is an oral CGRP receptor antagonist for the acute treatment of migraine, most plans gate it behind step therapy, demanding documented failure, intolerance, or a true contraindication to one or more oral triptans before they will cover a gepant, and they often challenge whether the headaches are migraine at all rather than tension-type or medication-overuse headache. We turn that around by anchoring the appeal to a G43 migraine diagnosis, a dated record of the specific triptans tried with the reason each was stopped, and your prescriber's note that Ubrelvy is being used for acute relief rather than prevention so the plan cannot misroute it to a preventive pathway. Supplied with that record, the medical necessity case for acute migraine abortive therapy becomes hard for a reviewer to brush aside.
Emgality (galcanezumab)
An Emgality rejection looks final on the page, but it is almost always a coverage hurdle built to make you stop, not a clinical conclusion. The most common reason this specific CGRP preventive gets rejected is step therapy: payers want proof you tried and failed at least two classes of older oral preventives, typically a beta-blocker like propranolol, an antiepileptic like topiramate, and a tricyclic like amitriptyline, before they will approve a galcanezumab injection. What reliably reverses that decision is a complete headache calendar establishing your monthly migraine-day frequency against the G43 ICD-10 codes, paired with a documented record of each prior preventive that failed or caused intolerable side effects, and for cluster-headache denials, the B-criteria pattern of episodic attacks that matches the label. Bring that history into focus and the medical necessity for Emgality becomes something a reviewer can no longer reasonably refuse.
Aimovig (erenumab (erenumab-aooe))
A denial of Aimovig is rarely the end of the road. It is usually the start of a documentation process, because most plans place this drug behind step therapy and prior authorization rather than excluding it outright. Aimovig denials are frequently overturned when the appeal clearly shows the migraine diagnosis, the older preventive medicines that were already tried and failed, and how the patient meets the plan's own coverage criteria.
Vyepti (eptinezumab)
A denial of Vyepti is not the end of the road. It is the opening move in a process that is frequently overturned on appeal. Most denials come down to two things the plan wants to see and that the original request did not fully document: proof that the right oral preventive medications or preferred CGRP agents were already tried, and a clear paper trail showing your migraine frequency and treatment response. When those gaps are filled, and the request is mapped to the plan's own coverage criteria, these decisions often reverse.
Qulipta (atogepant)
A denial of Qulipta is rarely the final word. It is the opening of a process, and these denials are frequently overturned when the appeal is built correctly. Qulipta is most often denied because the plan requires step therapy through older oral preventives first, or because the prior authorization criteria were not fully documented in the original submission. What flips the decision is a clear record of your migraine diagnosis, the preventives you have already tried and failed or could not tolerate, and a letter of medical necessity that maps your history directly to the plan's own coverage rules.
Asthma
Xolair (omalizumab)
An insurer's no on Xolair is seldom the end of the conversation, it usually marks a documentation gap that the policy itself tells you how to close. Because omalizumab is an anti-IgE biologic dosed off a strict serum-IgE and body-weight table, insurers most often reject it for a missing or out-of-range total IgE level, for asthma that is not yet documented as moderate-to-severe persistent on an inhaled corticosteroid plus LABA, or for chronic spontaneous urticaria without a recorded failure of H1 antihistamines at up-titrated doses. The appeal turns on supplying exactly what the policy demands: the in-range total serum IgE with weight to confirm the labeled dosing band, a positive perennial aeroallergen sensitivity test for the allergic-asthma indication, the right anchor code (J45.x for asthma, L50.1 for chronic spontaneous urticaria, J33.x for nasal polyps), and a clean prior-therapy log proving standard controllers fell short. Pin the request to Xolair's specific FDA-approved indication and the documentation transforms from a guess into a record the medical reviewer cannot dismiss.
Tezspire (tezepelumab)
A Tezspire denial almost never means the door is closed, it usually means the file in front of the reviewer is incomplete, and that is fixable. Because Tezspire (tezepelumab) is the one severe-asthma biologic approved without a phenotype or biomarker requirement, plans rarely contest the science and instead lean on step-therapy language, demanding you first fail an eosinophil-driven anti-IL5 or anti-IgE agent, or arguing the asthma was never documented as truly severe and uncontrolled. The appeal turns when the record carries a J45.5x severe persistent asthma anchor, a clear history of high-dose inhaled corticosteroid plus a second controller, and the exacerbation count, ACT scores, or oral-steroid bursts that prove inadequate control, which together establish exactly the population the label covers regardless of biomarkers. Build that evidence trail and the formulary objection loses its footing.
Nucala (mepolizumab)
A Nucala denial is rarely the final answer. It is usually the start of a process. Nucala is a high-cost biologic, so plans almost always require prior authorization and frequently demand step therapy through a preferred biologic or proof that your blood eosinophil count meets a specific threshold. When the denial is overturned, it is most often because the appeal documents the eosinophilic diagnosis with labs, shows the prior therapies that failed, and maps each plan criterion to your chart line by line.
Fasenra (benralizumab)
A Fasenra denial is the start of a process, not the end of it. This biologic is most often denied because the plan wants documented step therapy through inhaled controllers, a baseline blood eosinophil count on file, and prior-authorization criteria spelled out in the chart before it will approve a high-cost injectable. Appeals that map the patient's eosinophil level, exacerbation history, and failed prior therapies directly onto the plan's own written criteria are what flip these decisions.
Send the denial. We'll take it from here.
$0 to start. Ten percent only if we win. No card at intake. A senior reviewer reads your denial letter within 24 hours, then we prepare the appeal, file it with the carrier, and chase the decision. One fee, ten percent of whatever the carrier pays you, and nothing if we do not recover.