Prior authorization for GLP-1 receptor agonists
GLP-1 receptor agonist requests are reviewed closely, and the first thing a reviewer checks is whether the product requested matches the indication documented in the chart. Products in this class are licensed for different uses, so a request that mixes them up is refused quickly. This page covers what a factual, complete request contains.
Start with the documented indication
Some GLP-1 products are licensed to improve glycaemic control in type 2 diabetes, some for chronic weight management in adults who meet body mass index and comorbidity thresholds set in the product labelling, and some carry additional licensed uses. The same molecule may be sold under different product names for different indications.
Write to the indication that the chart supports and that the product is licensed for. A request for a diabetes product for a patient without diabetes, or a weight management product described as diabetes treatment, will not survive review, and it is not a position a clinician should put their name to. The letter should reflect the actual clinical decision made at the visit.
What reviewers typically look for
For type 2 diabetes, reviewers usually want:
- The diagnosis with recent HbA1c values and their dates.
- Prior and current glucose-lowering therapy, doses and duration, or a documented reason a first-line agent cannot be used.
- Relevant comorbidities that inform drug choice, such as established cardiovascular disease or chronic kidney disease, with their codes.
For chronic weight management, reviewers usually want a measured weight and body mass index with the date, the weight-related comorbidities that apply, and documentation of a structured diet and activity plan alongside the medicine. For both indications, the note should show screening for the contraindications listed in the product information, such as a personal or family history of medullary thyroid carcinoma or multiple endocrine neoplasia type 2, and a history of pancreatitis, and it should state that the patient is not taking another GLP-1 receptor agonist or a DPP-4 inhibitor at the same time.
Example
Request: GLP-1 receptor agonist, once weekly, for glycaemic control. Diagnoses: Type 2 diabetes mellitus with hyperglycaemia (E11.65); essential hypertension (I10); body mass index 33.0-33.9, adult (Z68.33). [Patient initials], 57. HbA1c 8.6% this month and 8.4% four months ago. Current therapy: metformin 1 g twice daily for 3 years, adherent by pharmacy refill history. A sulfonylurea was added 10 months ago and stopped after two documented hypoglycaemic episodes requiring assistance. Screening: no personal or family history of medullary thyroid carcinoma or MEN 2; no history of pancreatitis. Not on a DPP-4 inhibitor. Plan by treating clinician: add a once-weekly GLP-1 receptor agonist to metformin, with dietary review and repeat HbA1c in 3 months.
Continuation and common refusals
Renewal criteria for this class usually ask for evidence of response over a defined period: a fall in HbA1c for diabetes, or a percentage of body weight lost for weight management, measured against the baseline in the original request. Document the baseline and the follow-up value with dates.
Frequent refusal reasons are a missing HbA1c date, prior therapy named without duration, a body mass index stated without a measured weight, and an indication that does not match the product. Each is prevented by the note, not by the wording of the letter.
How ClearPass drafts the request
ClearPass writes the justification from the visit note and suggests ICD-10 codes, including body mass index Z codes when the note gives a measured value. It argues from the facts in the chart and does not add an indication that the chart does not contain. If a screening item or a prior therapy date is missing, it asks or lists the gap. The letter length can be Concise, Standard or Detailed, and you review and edit it before filing. It does not promise the request will be approved.
What ClearPass does not do
- It does not replace your judgement. Every note is an AI draft that you review and correct before it is used.
- It is not a medical device and does not make clinical decisions. It is a documentation aid.
- It does not connect to your EMR. The note is copy-ready text that pastes into any system.
Privacy
Clinical note content is not stored on ClearPass servers: it is processed to write the note, then discarded. Consultation audio is transcribed and discarded, never stored. Your note history stays in your browser, on your device, and you choose how long it is kept. Common identifiers are removed from typed and transcribed text before it reaches the AI; that is a best-effort safeguard, so leave names, ID numbers and file numbers out where you can. Processing goes through the AI providers named in our Privacy Policy, which sets out exactly what each one receives and how long it keeps it. ClearPass does not sign HIPAA business associate agreements today.
Questions
Can ClearPass write a GLP-1 request for weight loss in a patient with diabetes?
It writes to what the chart documents. If both conditions are documented and the product requested is licensed for the indication you choose, the letter will reflect that. Choose the product and indication yourself; the letter follows your clinical decision.
Which codes support a weight management request?
Typically a code for obesity, a body mass index code from the Z68 category that matches the measured value, and codes for the weight-related comorbidities present. Check them against the current code set.
Does it include dose recommendations?
No. It states the dose only if you decided and documented it. It does not recommend doses.
What does ClearPass cost?
The 7-day trial is free, needs no card and simply ends after 7 days, with no automatic charge. After that there is one plan: $78 a month or $858 a year, with every visit transcribed.
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