Sema prices are all over the place — anyone have experience?

Dr.GastroMayo said:

Denials are usually procedural rather than clinical, and the order that works reflects that.

Insurance update relevant to cost and coverage: I just got my prior auth approved through UnitedHealthcare after 3 attempts.

What finally worked: a letter from my endocrinologist documenting BMI history (>3 years), failed diet attempts, comorbidities (sleep apnea + prediabetes), and referencing the SELECT trial data.

If your PA keeps getting denied, don't give up. Request a peer-to-peer review between your doctor and the insurance medical director. That's what finally broke through for me.

One thing that is still open after Dr.RaviCardio’s answer:

How long did you give it before you decided it was working?

josh_phd_bmore said:

Insurance update relevant to cost and coverage: I just got my prior auth approved through UnitedHealthcare after 3 attempts.

Telehealth prescriber review for cost and coverage: I've used 4 different telehealth platforms to get my GLP-1 prescription. Comparison:

I settled on the one that required labs — it shows they care about safety, not just prescribing volume.

Reporting back.

Update: approved on the third attempt after a peer-to-peer. Nothing about my case changed; only who was doing the talking.

LindaRN_retired said:

Telehealth prescriber review for cost and coverage: I've used 4 different telehealth platforms to get my GLP-1 prescription.

Financial impact of cost and coverage weight loss beyond medication cost:

• Groceries: SAVED $228/month (eating less)
• Restaurants: SAVED $218/month (fewer meals out)
• Alcohol: SAVED $168/month (stopped drinking)
• Life insurance: Premium REDUCED by $38/month (lower BMI)
• Copays: SAVED $78/month (fewer BP/cholesterol meds)

Net impact after medication cost: approximately BREAKING EVEN. The medication pays for itself through reduced food spending and healthcare costs. This surprised me.