At Claimable, we’re dedicated to empowering patients to fight for the care that they deserve. That’s why, as of today, we’re officially supporting free second-level appeals for CVS Caremark Zepbound forced-switch denials — so you can be confident your case receives a full, fair, and individualized review.

First, What’s A Second-Level Appeal?

When you submit an appeal as a patient and it’s denied, it isn’t the end. You have the right to request a second-level appeal, which often involves review by a different department or an independent third party. Put simply? It’s another chance to have your case heard, and have your denial overturned.

Why We’re Escalating to Second-Level Appeals

Over the past weeks, we’ve had an influx of patients file appeals for Zepbound coverage with CVS Caremark. Unfortunately, we’ve begun to see responses to those appeals come back as form-letter denials – ignoring not only your unique health history, doctor’s notes, and plan details, but also state and federal laws. Federal rules are clear: every appeal must receive an individualized review. The copy paste answers we’re seeing? They’re not that.

In order to make sure that each of these appeals get the full and fair review they’re entitled to, it’s time to escalate it to the next level:

• Internal vs. External Reviews
  • Internal appeal: Your denial is reviewed by CVS Caremark or your insurer. Yes, the same company that issued the denial – though federal law requires that the review be conducted by someone who wasn’t involved in the original decision.
  • External appeal: Also called an external review or, in some states, an Independent Medical Review (IMR). This is conducted by a licensed medical professional or organization not affiliated with your insurance provider, using objective, evidence-based criteria. External decisions are binding on the insurer, but you may still have the right to pursue legal action if the outcome is unfavorable.

For forced-switch denials of Zepbound, we pursue the external review – most likely to secure the coverage you need — free of charge.

What to Expect If Your First Zepbound Appeal Is Denied

1. You Report the Denial
   Once you get the notification that your appeal has been denied, simply log into your Claimable account to report the outcome – or email us at support@getclaimable.com
2. You Consent To Escalation
   We’ll confirm you’d like to continue to escalate to a second-level appeal. At this point, you’ll upload your appeal denial letter.
   
3. We Build Your Strongest Case
   Once you consent, we’ll generate your second-level appeal package. This includes a newly drafted appeal letter with an expert legal opinion and your prior appeal materials.
4. You Review & Submit
   We’ll notify you when your second-level appeal is ready for review.You’ll confirm where to send (fax/mail) your appeal, then click “Submit” once everything looks right.
5. We Send – Expedited
   Claimable will fax and mail your appeal to both CVS and the independent reviewer. 
6. 
   Because all Zepbound forced-switch appeals involve ongoing treatment for a serious condition, your case will be marked urgent – requesting an expedited external review. This means that in most cases, the reviewer must issue a decision within 72 hours, though some may take longer.
   
7. You Get Notified
   You’ll be notified of the outcome via portal message, email, or phone, as well as receiving a mailed copy of the decision.
   

If it’s approved? The decision is binding – and CVS must cover your Zepbound.

Key Questions – Answered

What is a second-level appeal?

It’s your right to request another review when your first appeal is denied—either internally by the insurer or externally by an independent reviewer. We choose the path most likely to win for you.

Why is Claimable offering free 2nd-level appeals?

With these early Zepbound appeals, we’ve seen a clear pattern of “cookie-cutter” denials that violate the full-fair-and-individualized-review requirement. To level the playing field, we’re offering these escalations free of charge to demand unbiased consideration.

Keep in mind, this only applies if you submitted your first-level appeal through Claimable. If you've appealed a different way and think you might need a second-level appeal, feel free to email us for help navigating the process.

What’s included in my Claimable second-level appeal?

A freshly drafted appeal letter with expert legal commentary, your first appeal materials, and previous denial letters—packaged to maximize your chance of success.

Is there any cost to second level appeals?

Nope – this service is completely free for CVS Caremark Zepbound forced-switch cases. Claimable’s appeal strategy is customized for each insurer and medication—and in these cases, supporting a second-level appeal is part of our core approach to winning.

What do I need to submit a second-level appeal?

You’ll need your appeal denial letter to confirm the instructions for submitting a second-level appeal, including where to send it and whether any forms are required.

If you’ve received your claim file and designated record set since initially submitting, we recommend uploading them when prompted (after you review your second-level appeal draft).

How do I track my appeal’s status?

If you haven’t heard back within 72 hours, call the number on your insurance card. Otherwise, we’ll notify you as soon as the reviewer issues a decision.

Do I have to redo the appeal questionnaire?

Never. All your first-level answers and uploads carry over automatically.

We know the appeals process can feel confusing and overwhelming. That’s why we built Claimable — to guide you every step of the way. With our new second-level appeal support, you can rest assured that we’ll fight tirelessly to get you the coverage you deserve.

Questions? We’re here for you. Reach out to support anytime.

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