Your insurer's requirement that your prescriber justify a medication, with documentation, before the plan will cover it. It's the single most common paperwork hurdle for GLP-1 coverage and a frequent source of delays. A well-documented PA letter (citing your diagnosis, prior treatments tried, and the relevant guidelines) is what gets it approved.
Related terms: Appeal (insurance) · Step therapy · Formulary · Comorbidity
See also: PA letter templates