Anthem/Elevance Health GLP-1 Coverage

Step therapy may be required — you may need to try a lower-cost medication first.

• •Coverage requires prior authorization and specific clinical criteria.
• •All GLP-1s are covered with PA, but Foundayo is pending.
• •Copays vary based on diagnosis and plan tier.
• •Step therapy is required unless medically justified.

1. 1.Submit PA request through the Elevance Health online portal.
2. 2.Ensure your diagnosis code matches the required criteria (e.g., BMI ≥30 or diabetes).
3. 3.Ask your provider to include a treatment plan that shows failed lifestyle interventions.

1. 1.Appeal with a letter from your provider and updated lab results.
2. 2.Request a peer-to-peer review if the denial is based on formulary exclusion.
3. 3.Highlight any comorbidities like hypertension or prediabetes in your appeal.

• GLP-1 Denied by Insurance? Your Complete Action Plan for 2026
• Prior Authorization for Medications: How to Get Approved in 2026
• Insurance Stopped Covering Your GLP-1 in 2026: What to Do Next