Prior Auth Copilot · demo

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Request

Expedited · 72 h

Member: Synthetic M-33960, 46 F, Commercial HMO (sample)
Service: NDC 00169-4525 Semaglutide (Wegovy) 0.25 mg/0.5 mL pen
Diagnosis: E66.3 Overweight; I10 Essential hypertension
Provider: Riverbend Primary Care, Internal medicine, in-network
Policy: DEMO-RX-031 Semaglutide (Wegovy) for chronic weight management

Primary care visit

note-1 · 2026-10-21

Patient: Priya Raman   DOB: 06/19/1980   MRN: 00655120
Callback: (555) 742-0193

Subjective: 46 y/o F here to discuss weight. Weight has gone from 152 lb to 171 lb over 2 years. Hypertension diagnosed 2024, controlled on lisinopril.

Vitals: Height 5'5", weight 171 lb, BMI 28.4. BP 132/84.

Problem list: Essential hypertension. Overweight. Prediabetes (A1c 6.0).

Assessment/Plan: Overweight with hypertension. Discussed diet and exercise. Will start semaglutide 0.25 mg weekly and titrate.

Pharmacy claims, last 12 months

rx-1 · 2026-10-28

2025-11-03  lisinopril 10 mg tab  #90
2026-02-02  lisinopril 10 mg tab  #90
2026-05-04  lisinopril 10 mg tab  #90
2026-08-03  lisinopril 10 mg tab  #90
No GLP-1 receptor agonist claims in this period.

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Synthetic members and illustrative policies. Not for clinical or coverage decisions.