Prior authorization denied: appeal by drug
To overturn a prior authorization denial, match the insurer's own medical policy line-by-line: cite the policy name, document each criterion in the chart, and attach the evidence the policy names (labs, imaging, prior-therapy history). Federal rules give you 180 days to file an internal appeal under 29 CFR § 2560.503-1.
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Wegovy (semaglutide)
GLP-1 for weight management
Zepbound (tirzepatide)
GIP/GLP-1 for weight management
Ozempic (semaglutide)
GLP-1 for type 2 diabetes
Mounjaro (tirzepatide)
GIP/GLP-1 for type 2 diabetes
Saxenda (liraglutide)
GLP-1 for weight management
Humira (adalimumab)
TNF inhibitor
Stelara (ustekinumab)
IL-12/23 inhibitor
Enbrel (etanercept)
TNF inhibitor
Dupixent (dupilumab)
IL-4/13 inhibitor
Skyrizi (risankizumab)
IL-23 inhibitor
Trikafta (elexacaftor/tezacaftor/ivacaftor)
CFTR modulator
Eliquis (apixaban)
DOAC anticoagulant
Jardiance (empagliflozin)
SGLT2 inhibitor
Vyvanse (lisdexamfetamine)
Stimulant for ADHD or BED
Empaveli (pegcetacoplan)
Complement inhibitor for PNH
Rinvoq (upadacitinib)
JAK inhibitor for RA, PsA, AD, UC, Crohn's, AS
Cosentyx (secukinumab)
IL-17A inhibitor for PsO, PsA, AS, nr-axSpA, HS, ERA, JPsA
Taltz (ixekizumab)
IL-17A inhibitor for PsO, PsA, AS, nr-axSpA, pediatric PsO
Tremfya (guselkumab)
IL-23 inhibitor for PsO, PsA, UC, Crohn's
Entyvio (vedolizumab)
Integrin inhibitor for UC and Crohn's
Remicade (infliximab) and biosimilars
TNF inhibitor (IV infusion) for RA, PsA, AS, PsO, Crohn's, UC
Otezla (apremilast)
PDE4 inhibitor for PsO, PsA, Behçet's oral ulcers
Xolair (omalizumab)
Anti-IgE for allergic asthma, CIU, nasal polyps, food allergy
Fasenra (benralizumab)
Anti-IL-5Rα for eosinophilic asthma, EGPA, HES
Nucala (mepolizumab)
Anti-IL-5 for eosinophilic asthma, EGPA, HES, nasal polyps
Epidiolex (cannabidiol)
CBD for Lennox-Gastaut, Dravet, TSC-associated seizures
Spravato (esketamine)
NMDA antagonist for treatment-resistant depression and MDD with suicidality
Austedo (deutetrabenazine)
VMAT2 inhibitor for tardive dyskinesia and Huntington's chorea
Leqembi (lecanemab)
Anti-amyloid mAb for early symptomatic Alzheimer's
Hemgenix (etranacogene dezaparvovec)
Gene therapy for hemophilia B
Upload your PA denial for a free analysis
The free read identifies what your insurer requires, what evidence is missing, and whether a step-therapy override applies.
Not legal or medical advice. This page is a self-help resource. You make your own decisions. Strip personal identifiers (name, date of birth, address, member ID) from any document before uploading or sharing. The information here summarizes commonly-published payer policies and federal rules; confirm against your specific plan document and the current denial letter before acting.