My insurance FINALLY approved it - here is exactly what I did — 12 month update

Can confirm about Cigna specifically — they are the WORST for GLP-1 PAs. My practice has a 23% first-attempt approval rate with Cigna vs. 71% with UHC and 65% with Aetna. Cigna's step therapy requirement means you usually have to fail phentermine or orlistat first, and they want 90 days documented on each. So you're looking at 6 months of failed medications before they'll even consider a GLP-1.

For anyone dealing with step therapy requirements: ask your doctor to document a clinical contraindication to the step therapy drugs. Phentermine is contraindicated with uncontrolled hypertension, certain cardiac conditions, and hyperthyroidism. Orlistat is contraindicated with cholestasis or chronic malabsorption. If you have ANY of these, the step therapy can be bypassed. My doctor documented my tachycardia history and Cigna waived the phentermine requirement.

UPDATE: you were RIGHT. I called Cigna and had them read back the PA details. My height was entered as 5'4" instead of 5'10". With the wrong height my BMI calculated as 28 instead of 36. My doctor's office resubmitted with correct measurements and it was approved in 48 hours. I cannot believe a typo cost me three months of denials and appeals. I'm furious but also relieved.

YES! So glad you caught that. A 6-inch height error is wild but honestly not surprising — data entry mistakes are one of the most common reasons for PA denials and nobody thinks to check. For everyone else, here's my PA preparation checklist: - ✓ Get your plan's specific coverage criteria document - ✓ Verify all demographic/biometric data is correct in your chart - ✓ Document 6+ months of lifestyle modification attempts - ✓ Have relevant labs drawn within 90 days - ✓ List all relevant diagnosis codes - ✓ Use the insurer's specific PA form - ✓ Submit electronically, early in the week - ✓ Attach all supporting documentation upfront Do all of this and your chances go up dramatically.

Saving this entire thread. Starting the PA process with Express Scripts next week for Mounjaro. My doctor already has my 8 months of Noom records and dietitian visits documented. Going to call Express Scripts tomorrow to get the coverage criteria document. Feeling way more confident now.