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What to submit: Completed appeal form (available on CVS Caremark member portal) Letter from prescriber explaining why denial was incorrect Supporting documentation: BMI measurements, lifestyle intervention logs, documentation of step therapy completion or contraindication, peer-reviewed studies supporting use Success rate: 24% of standard appeals result in approval (CVS Caremark 2025 data)

Medicare and Medicaid: Coverage can vary based on state and specific plan, but many plans include tirzepatide with prior authorization

Please schedule an appointment with a doctor for a detailed assessment and advice

Aug 2019;37(8):1577-1584

In the PIONEER program, four trials compared once-daily oral semaglutide with the active comparators sitagliptin, the SGLT2i empagliflozin, and liraglutide (2830, 33)

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