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Standard appeal (Level 1): Must be filed within 180 days of the denial date Submitted by the prescriber (patient can submit but prescriber submission is more effective) Reviewed by a different clinical reviewer than the initial denial Decision timeline: 30 days for standard, 72 hours for expedited Success rate: approximately 22% for Zepbound appeals per the Patel 2025 study External review (Level 2): Available only after Level 1 appeal is denied Reviewed by an independent third-party physician not employed by Express Scripts Must be filed within 60 days of Level 1 denial Decision timeline: 45 days Success rate: approximately 38% for weight-management medication appeals per a 2024 NAIC report on external review outcomes The appeal success rate is higher if the denial was due to missing documentation (easy to fix by submitting the missing records) than if the denial was due to not meeting clinical criteria (harder to argue your BMI is different than what was measured)

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