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The protocols used for brand versions of tirzepatide (Mounjaro, Zepbound) and semaglutide (Ozempic, Wegovy) are the averaged result of studies on large patient samples

Category 3: Medical necessity not established (10% of denials) BMI below threshold Insufficient duration of prior treatment attempts Contraindication present (family history of medullary thyroid cancer, pregnancy) Solution: If clinical facts support coverage, file a formal appeal

Additionally, we excluded non-randomized studies, observational studies, case reports, reviews, letters to the editor, non-human studies, non-English articles, conference proceedings, and non-peer-reviewed articles

And just automatically, when you come up blank as a clinician, not to automatically assume, its all in her head

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