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Prior authorization: the process, timeline, and approval rates Prior authorization for Wegovy under Medi-Cal requires your provider to submit: Clinical documentation: Current BMI (measured within 30 days) Documented comorbidities with ICD-10 codes History of previous weight-loss attempts (3 to 6 months of diet/exercise counseling, participation in a structured program, or previous pharmacotherapy) Baseline labs (A1C if diabetic, lipid panel if dyslipidemia is the qualifying comorbidity) Prescriber attestation: Patient has been counseled on diet and exercise Patient does not have contraindications (personal or family history of medullary thyroid carcinoma, multiple endocrine neoplasia syndrome type 2, history of pancreatitis) Treatment is medically necessary Plan-specific forms: Each managed care plan has its own prior auth form (not interchangeable) Most plans accept electronic prior auth through Surescripts or CoverMyMeds Fee-for-Service Medi-Cal uses the Medi-Cal Treatment Authorization Request (TAR) form Approval timeline: California law requires managed care plans to respond to prior authorization requests within 5 business days for urgent requests, 14 calendar days for standard requests