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Cahana, I
The label must show: - Drug name (semaglutide or tirzepatide) with B12 disclosure - Concentration in mg/mL - Total volume in mL - Lot or batch number - Expiration date - Compounding pharmacy name - Storage instructions (typically refrigerate between 2 to 8 degrees C) Insulin syringes
Common reasons appeals succeed: The denial cited insufficient documentation, and the provider submits complete records showing all criteria were met The denial incorrectly stated the patient had not tried metformin, when pharmacy records show a 90-day trial The denial applied the wrong clinical criteria (e.g., requiring BMI 30 when the actual requirement is BMI 27 for diabetes patients) Common reasons appeals fail: The patient is requesting coverage for obesity without diabetes (no amount of documentation overcomes a formulary exclusion) The patient has not completed the required step therapy (metformin trial) The provider requested Wegovy instead of Ozempic for a diabetes patient (the appeal should request Ozempic instead) Step 3: Judicial review (within 30 days of Board of Hearings decision) If the Board of Hearings upholds the denial, you can file an appeal in Massachusetts Superior Court
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