Insurance answers
Prior Authorization for GLP-1 Medications
Prior authorization is a plan requirement that your clinician document specific criteria before the pharmacy benefit will pay for a medication. It is the most common delay in starting GLP-1 therapy.
What plans typically ask for
Common criteria include a documented BMI threshold, weight-related conditions, evidence of a supervised lifestyle intervention, and sometimes step therapy through a lower-cost option first.
Turnaround is often a few business days but varies by plan and can require appeal.
How to speed it up
Bring prior weight records, documentation of previous attempts, and a complete medication list to your visit. Missing documentation is the leading cause of avoidable denials.
How FRDC handles this
Choose Insurance on the new patient intake and enter your carrier. Our team verifies your benefits before your first visit and tells you what you will owe. If your plan is one we are not contracted with, the intake form tells you immediately and shows you the self-pay path instead of letting you find out later.
Self-pay pricing is published: $150/month clinic fee (once every 90 days at maximum Mounjaro dose), Phentermine + B12 $84/month, Mounjaro or Zepbound $399–499/month, Ozempic or Wegovy $199–399/month, B12 injections $15 each. Your information is used only to schedule and verify coverage.
Results framing
Your clinician sets your goals — many plans target 10–16 lbs/month with strict protein protocols; individual results vary.
Medication and dosing are always determined by your clinician after evaluation.
Frequently asked questions
- How long does prior authorization take?
- Usually several business days, though plans differ and appeals add time.
- Can I start while waiting?
- Some patients begin self-pay and switch once approved. Discuss options with your clinician.
- What if it is denied?
- Appeals are possible, and your clinician can discuss covered alternatives.
Keep reading
- Medicaid and Weight Management in Maryland
Maryland Medicaid is delivered through managed care organizations, and weight-management coverage differs between them and changes with state formulary dec
- Medicare and Weight Management
Medicare's treatment of weight-management care is narrower than most commercial coverage, and Part D historically excluded medications used solely for weig
- Silver Spring clinic & Maryland telehealth
In-clinic at 11303 Amherst Ave STE 2, Silver Spring, MD — plus telehealth across Maryland, including Saturday and Sunday.
- FRDC blog
Articles on pain care access, GLP-1 program costs, telehealth, and insurance in Maryland.