Cost-effectiveness analysis: GLP-1 agonists vs bariatric surgery (ICER 2026) — looking for input

Taking the question as asked, rather than the general version of it. Denials are usually procedural rather than clinical, and the order that works reflects that. Get the denial reason in writing, because it names the criterion you failed. Then supply the documentation that criterion asks for — usually documented BMI with a comorbidity, or a failed prior therapy. Then appeal, and ask for a peer-to-peer review, because a prescriber talking to a reviewing clinician resolves a large fraction of denials that written appeals do not. Manufacturer copay assistance is separate and applies mainly to commercial insurance, and patient assistance programmes are means-tested rather than a discount.

amsterdam_pete said:

Denials are usually procedural rather than clinical, and the order that works reflects that.

Agreed, and coverage criteria are plan-specific rather than insurer-specific. Two people with the same insurer and different employers have different rules, which is why "my insurer covers it" is not transferable information.

Ask again with the specifics and you will get a better answer than this one.

SkepticalSean said:

I have a procedure booked and the pre-op paperwork asked about GLP-1 medication in a way that suggested somebody had recently been caught out.

Can confirm. Same sequence, different timescale.

Adding the clinical framing, because it changes how the question reads.

Timing surgery and anaesthesia around surgery: my surgeon required me to stop GLP-1 agonists 2 weeks before my scheduled procedure due to aspiration risk from delayed gastric emptying.

If you have any upcoming surgeries or procedures requiring anesthesia, TELL YOUR SURGEON AND ANESTHESIOLOGIST that you're on a GLP-1. This is critical for safety.