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Records for insurance renewals

In the United States, many insurance plans require prior authorization before they cover a GLP-1 medicine, and many ask for it to be renewed. Renewals usually turn on documentation your prescriber submits. A clean, dated record makes that paperwork faster and more accurate.

By the Cafeity teamUpdated 2 min read

The short answer

Prior authorization criteria for GLP-1 medicines vary by insurance plan, and renewals may ask your prescriber to document things such as your starting weight and BMI, how your weight has changed since starting, and that you are taking the medicine as prescribed. The only reliable source for your plan's criteria is the plan itself. A dated record of doses, weight as a trend, and side effects lets your prescriber answer quickly and accurately; Cafeity's Visit Summary produces that on one page.

What prior authorization is

Prior authorization is a requirement by a health plan that a prescriber get approval before a medicine is covered. For GLP-1 medicines used for weight management, approvals are often time-limited, and continuing coverage can depend on a renewal with updated information. The criteria are set by each plan and change over time.

What is worth keeping

  • Your starting weight, height and the date — measured the way you will measure later.
  • Your weight over time as a trend, with dose changes marked.
  • Every dose with its date — including late or missed ones.
  • Side effects and anything that affected treatment.
  • Changes to eating and activity, if your plan asks about them.
  • Other conditions that may be relevant to coverage, as your prescriber advises.

Guidelines outside the US set similar expectations: in England, for example, NICE guidance asks prescribers to review treatment if less than 5% of starting weight has been lost after six months.12 A record that shows the trend clearly makes that review straightforward.

Getting your plan's exact criteria

Ask your insurer, or your prescriber's office, for the plan's prior authorization criteria and the renewal form for your specific medicine. Many plans publish these. Knowing the dates and measurements they want before your follow-up appointment saves a second visit.

Keeping a record of it

Cafeity's Visit Summary builds one page from any period you choose — medication and doses with adherence and dose changes, the weight trend and total change, symptoms against doses, and notes you tagged for your prescriber. It is a record, not a claim form, but it holds most of what a renewal asks for.

Cafeity Visit Summary set-up: a period picker (4 weeks, 3 months, 6 months, custom) and switches for medication and doses, weight trend, body measurements, symptoms, protein and energy, activity and sleep, and notes tagged for the prescriber.
The Visit Summary.
Cafeity weight screen showing a smoothed trend weight of 115.6 kg, down 5.5 kg since last week, with the note "Based on your recent rate. Not a prediction."
The weight trend and total change.

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Common questions

What do insurers ask for to renew a GLP-1?
It varies by plan. Renewals may ask for documentation of weight change since starting and of ongoing treatment; ask your plan or prescriber's office for the exact criteria.
Can Cafeity send records to my insurer?
No. Cafeity creates a Visit Summary that you can give to your prescriber, who handles the authorization.

Sources

  1. Semaglutide for managing overweight and obesity (TA875) National Institute for Health and Care Excellence
  2. Tirzepatide for managing overweight and obesity (TA1026) National Institute for Health and Care Excellence

Written by the Cafeity team from the sources listed here. Figures from prescribing information are quoted as the label states them; trial results are averages from those trials, not predictions for any one person. This page has not yet been reviewed by a clinician — see the editorial policy for how pages are researched and corrected.