Coverage renewal brief

Coverage for a GLP-1 often needs renewing — a prior authorization in the US, or a special authority or private-plan approval in Canada. This brief helps you gather what your plan asks for, keep four easily-confused dates apart, list your documents, and print a one-page summary for your prescriber. It saves only in this browser, on this device; there is no account and nothing is sent.

It is an organizer. It does not decide whether you are eligible, predict approval, write medical-necessity text, recommend a medicine or submit anything — your plan's own letter and form take precedence. For how renewals work, read the US guide or the Canada guide.

The details you enter stay in this browser.

Your country:

1. Choose a checklist

Blank renewal checklist (any plan)Works for any plan — use your plan's own letter or form as the sourceSample: Desjardins Group Insurance obesity-drug request (12607E)Canada · 12607E (2026-09)Sample: Express Scripts Canada Wegovy prior authorization formCanada · No version code printed; PDF dated 2026-07-28Sample: CVS Caremark standard tirzepatide criteria (6947-C)United States · Reference 6947-C (document dated 2026-03-12)

Your progress is saved separately for each checklist.

2. What the renewal asks for

0 done · 0 don't apply · 11 to do. Ticking items here doesn't mean a renewal will be approved — only your plan decides.

You can gather this

Your starting weight and the date (your own record)Status for: Your starting weight and the date (your own record)
Your current weight and the date (your own record)Status for: Your current weight and the date (your own record)
Other coverage you have (another private plan, a public plan, a patient-support program)Status for: Other coverage you have (another private plan, a public plan, a patient-support program)

From your prescriber or clinic record

Starting and current measurements as recorded by your clinic — plans may ask for these rather than home readingsStatus for: Starting and current measurements as recorded by your clinic — plans may ask for these rather than home readings
Current dose and how long you have been on it, from your prescriber's recordStatus for: Current dose and how long you have been on it, from your prescriber's record
The diagnosis or reason for use on file with your prescriberStatus for: The diagnosis or reason for use on file with your prescriber

Paperwork and timing

Find your current approval letter and note when the authorization endsStatus for: Find your current approval letter and note when the authorization ends
Get the plan's current renewal form or criteria (from your plan, PBM, pharmacist or prescriber)Status for: Get the plan's current renewal form or criteria (from your plan, PBM, pharmacist or prescriber)
Ask who submits the renewal — for many plans it is the prescriber, not youStatus for: Ask who submits the renewal — for many plans it is the prescriber, not you
Book an appointment before the end date, leaving time for the plan to decideStatus for: Book an appointment before the end date, leaving time for the plan to decide
Keep copies of what was sent, and the date it was sentStatus for: Keep copies of what was sent, and the date it was sent

Where your own list came from (optional)

Your plan's letter or form always outranks this checklist.

3. Dates — four different things

A prior authorization or special authority ending is not the same as your prescription expiring, your next refill, or an appeal deadline. Keep them apart, and mark any you don't know as unknown.

Prior authorization / special authority endsI don't know this date

From your plan's approval letter. This is the coverage approval, not your prescription. Status: not entered.

Prescription expires or runs out of refillsI don't know this date

From your pharmacy label or pharmacist. A valid prescription doesn't mean coverage is approved. Status: not entered.

Next refill dueI don't know this date

When you expect to need your next fill. Status: not entered.

Appeal deadline (only if you were denied)I don't know this date

From the denial letter. Leave as unknown if you haven't been denied. Status: not entered.

4. Attachment index

List the documents you or your prescriber will include — descriptions only. Nothing is uploaded, and nothing you type leaves this device.

5. Save it, or set a reminder

Files are made in your browser and saved to your device. Nothing is emailed, uploaded or submitted.

Restore from a downloaded copy

The file is read in your browser. Nothing is uploaded.

Optional calendar reminderBefore my authorization ends:

Enter the authorization end date in step 3 first, or choose your own date.

On a date I choose:

Preview

Title: Check renewal paperwork · no date chosen yet · no other details

This downloads a calendar file (.ics). When you open it, your calendar app adds the event. If your calendar syncs to an online account, that service will store the title and date — so the title is deliberately generic, with no medicine, insurer, weight or policy number, and no notes.

Renewal brief — handoff summary

Blank checklist — your own plan's letter or form is the source.

Prepared Nov 3, 2026 from: Blank renewal checklist (any plan)

Checklist

[To do] Find your current approval letter and note when the authorization ends (paperwork)
[To do] Get the plan's current renewal form or criteria (from your plan, PBM, pharmacist or prescriber) (paperwork)
[To do] Ask who submits the renewal — for many plans it is the prescriber, not you (paperwork)
[To do] Your starting weight and the date (your own record) (self-reported)
[To do] Your current weight and the date (your own record) (self-reported)
[To do] Starting and current measurements as recorded by your clinic — plans may ask for these rather than home readings (clinical record)
[To do] Current dose and how long you have been on it, from your prescriber's record (clinical record)
[To do] The diagnosis or reason for use on file with your prescriber (clinical record)
[To do] Other coverage you have (another private plan, a public plan, a patient-support program) (self-reported)
[To do] Book an appointment before the end date, leaving time for the plan to decide (paperwork)
[To do] Keep copies of what was sent, and the date it was sent (paperwork)

Dates

Prior authorization / special authority ends: not entered
Prescription expires or runs out of refills: not entered
Next refill due: not entered
Appeal deadline (only if you were denied): not entered

Attachments (descriptions)

None listed.

An organizer, not a decision. It does not decide eligibility, predict approval, write medical-necessity statements, recommend a medicine or submit anything. The plan's own form and letter take precedence.