External review is the step after your insurer's internal appeal: an independent review organization, not the plan, looks at the denial and decides whether the medication should be covered. Under the Affordable Care Act, most plans must offer it for denials based on medical necessity or similar judgments, and the decision is binding on the insurer. Standard external reviews are decided within 45 days; an expedited review for urgent situations can be decided within 72 hours.
For GLP-1 denials, external review is where a well-documented case — diagnosis, BMI or comorbidity records, prior treatments tried, and a letter of medical necessity — gets a fresh set of eyes. Your denial notice should explain how to request it; see escalation paths beyond your insurer and my insurance denied coverage — what now?.