# GLP-1 access depends on more than BMI.

**The indication, benefit, and continuation rules must agree.** Foresight checks the chart against the patient's plan, collects missing evidence at intake, and prepares initial and renewal requests for clinician sign-off.

## What this changes for the practice

- Indication-specific PA evidence
- Benefit exclusions identified early
- Weight-response evidence ready for renewal

## What Foresight checks

### Indication and benefit

Match the documented indication to the requested drug and benefit. Keep obesity, diabetes, cardiovascular, and sleep-apnea criteria distinct. Check the PBM, formulary, exclusions, and step therapy before drafting a request that the plan will not cover.

### BMI and comorbidities

Use dated height, weight, and BMI records, with the comorbidities required for that indication. Reconcile diagnoses, BMI Z-codes, labs, and questionnaire answers so the evidence supports the same request throughout.

### Prior treatment

Collect the lifestyle-program history, previous therapies, response, and contraindication screening required by the payer. Missing evidence becomes a specific intake question before the clinician reviews the PA.

### Continuation and renewal

Track the authorization end date alongside baseline and current weight, adherence, and treatment response. Apply continuation criteria to the longitudinal record; an initial-authorization checklist is not sufficient for every renewal.

## From intake to payment

1. **Intake** — Verify the plan and indication. Collect the BMI timeline, comorbidity history, and prior-treatment evidence before the visit.
2. **Payer checks** — Check the formulary and clinical criteria. Flag missing evidence or conflicts between the chart and requested therapy.
3. **Clinician sign-off** — Present the drafted answers and supporting chart evidence. Submit only after clinician approval.
4. **Decision and renewal** — Track the payer response, route denials for review, and collect continuation evidence before authorization expires.

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