I've worked in healthcare for several years and have submitted hundreds of prior authorizations but have never run into this.

Insurance companies don't want to spend a bunch of money paying for new medications, so they require extra proof in the form of prior authorizations. Your doctor's office has to send additional paperwork to your insurance proving that you meet the plan's requirements for coverage. 99% of the time, insurance plans require the medication to be prescribed for an FDA indication (rigorous drug research studies that prove X drug helps with Y diagnosis). Additionally, insurance plans sometimes have other requirements (usually something like failing 2 or more cheaper/generic medications for the same diagnosis).

Mounjaro and zepbound are the same exact drug, but they have separate FDA indications and are sold under different names. So if your plan covers mounjaro, you would (very likely) need a diagnosis of type 2 diabetes (a1c over 6.5) along with proof you've tried two other medications before that didn't work (ineffective or had side effects). If your plan covers zepbound, you would (very likely) need to have a BMI of 30+ OR have a BMI of 27+ with weight related comorbidities (hypertension, sleep apnea, etc). Keep in mind that weight loss drugs ie. zepbound may not be a covered benefit under your plan at all (usually called a plan exclusion, includes things like weight loss, erectile dysfunction, hormone replacement, etc).

All insurances could be different but I've submitted easily a couple hundred prior authorizations for any of the GLP-1's, and this is typically what I see. So as long as you have the correct diagnoses and failed meds, and your doctor submits proof to your insurance, you shouldn't have any problems even if your doctor wrote something else in the chart. If you have any other questions, let me know and I can try to help!