Things to Keep in Mind Wegovy is preferred on most Aetna plans CVS Caremark made it their primary GLP-1 in July 2025 Prior authorization is required you'll need to meet BMI and documentation criteria If denied, file an appeal 65%+ of appealed denials are overturned when properly documented [5] Cardiovascular benefit strengthens your case Wegovy is FDA-approved to reduce heart attack/stroke risk (March 2024) If your PA is denied, don't give up most denials can be overturned with the right documentation
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Therefore, we proposed, for CY 2026, to continue to assign CPT code 78431 to APC 1522 (New TechnologyLevel 22 ($2001-$2500)) with a payment rate of $2,250.50
On the other hand, ipamorelin is a growth-hormone secretagogue that activates the receptors of the hunger hormone ghrelin in the pituitary gland
When you speak with an insurance representative, here are some questions to ask: Does my plan cover Wegovy or Zepbound for weight loss