A 53-year-old executive assistant had been prescribed Zepbound for chronic obesity after years of failed medications, lifestyle changes, and worsening health. It was the only treatment that brought measurable improvement. When her insurer dropped coverage, she rationed doses every 10 days and feared relapse. Despite meeting criteria and multiple appeals from her doctor, CVS Caremark denied coverage and insisted she restart failed treatments. By the time she found Claimable through the Obesity Action Coalition, she had spent weeks fighting the denial and was already seeing setbacks, including a rising A1C and worsening symptoms. Her 21-day care gap was already taking a measurable toll.

Claimable drafted a comprehensive appeal addressing the medical necessity of Zepbound, the inappropriateness of restarting failed therapies, and the legal concerns raised by the insurer’s forced non-medical switch. The letter highlighted the patient’s documented history of step therapy failure, cited clinical guidance on GLP-1s, and detailed the risks of treatment interruption in a high-risk patient with multiple comorbidities. It also included a legal opinion from a renowned healthcare attorney and Claimable legal advisor, outlining potential violations in CVS Caremark’s systemic denials of Zepbound.