Has anyone successfully argued that their GLP-1 is medically necessary after losing enough weight that they technically no longer meet the BMI criteria they were approved under?
You get approved at BMI 34. The medication works. You're now at BMI 26. Your insurer's criteria requires BMI 30 or above. The medication is the reason you no longer qualify for the medication.
I know the clinical argument: stopping leads to regain, obesity is chronic, the medication is maintaining a result not producing a new one. I know that argument is correct. I don't know how to make it land with an insurance reviewer in a way that results in continued coverage.
u/roman_arc_0695 — 15 hours ago