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What the PA form requires: Diagnosis code (E11.9 for type 2 diabetes is standard) Most recent A1C result (must be ≥7.0% on most plans, ≥8.0% on some Medicaid plans) Current diabetes medication list (must show metformin trial unless contraindicated) BMI documentation (most plans require BMI ≥27 with comorbidity or ≥30 without) Cardiovascular risk factors if applicable (history of MI, stroke, PAD) Trial and failure documentation for other GLP-1 agonists if this is a switch request Common denial reasons (Anthem PA denial data, 2024-2025): A1C below threshold (38% of denials)
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