What 'checklist' means here
VitalHound prints an educational path plus a checklist a licensed clinician can use to submit prior authorization. It is not the submitted PA, not a CMS determination, and not a prescription.
Bring it printed or as a PDF. Clinics lose portal messages. Paper still files.
Identity and coverage, without improv
Legal name as on the Medicare or commercial card, state, coverage type (commercial, PDP, MA-PD, Medicaid, TRICARE, other government, or none), Extra Help yes/no, and whether a 2026 Part D GLP-1 already filled.
If an adult child assembled the form, say so. The clinician needs to know who will be in the room and who is authorized to hear results.
The clinical facts the PA will recite
Indication in chart language: weight management, type 2 diabetes, moderate-to-severe OSA, MASH, or another labeled use. Door choice follows that sentence.
Height, weight, BMI, and the date those were measured. Tried-and-failed lifestyle interventions if the plan asks. Contraindication review (including boxed-warning items the label names). Preferred product: Foundayo, Wegovy pill, Wegovy pen, Zepbound KwikPen — not 'a GLP-1.'
Routine and device lines people forget
Whether an empty-stomach window is workable, and the list of morning orals. That decides Wegovy pill versus Foundayo versus an injection.
If Zepbound: KwikPen and the pharmacy NDC. Other presentations are not on Bridge.
Money notes that belong on the same sheet
If Bridge: $50 does not count toward deductible or TrOOP; Extra Help does not apply; sunset 31 December 2027.
If commercial: run PA first, then the savings card, and only if the member is not on government coverage. If cash: current NovoCare or LillyDirect figure (Wegovy pill 4 mg $149 through 31 August 2026, then $199; Foundayo lowest dose often ~$149). If a bundle near $449 appears, write it down as the number to beat, not the number to accept.
What not to bring
A printout promising the plan 'covers it.' A savings card that names a different beneficiary. Someone else's leftover pens. A BMI from a smart scale this morning presented as last year's clinic weight.
Questions
Does the clinician have to use VitalHound's wording?
Can I submit this to CMS?
How long should the visit be?
Is this medical advice?
Not sure this applies to you?
Answer a few questions and see your own numbers.
Free to see which path is likely cheapest for your coverage.
Check my options