coverage criteria

Integrating Eligibility Tools and PA Systems for Wegovy and Zepound

Prior authorization (PA) Eligibility tools and prior authorization for Wegovy and ZepBound are two critical components in ensuring patient access to these high-cost GLP-1 medications. Eligibility tools confirm whether a patient’s insurance is active and what services are covered, while prior authorization verifies that the prescribed treatment meets the insurer’s medical necessity criteria before approval. Integrating eligibility tools and prior authorization for Wegovy and ZepBound through real-time technology and digital workflows leads to faster approvals, reduced delays, and improved patient