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ForumsVendor ReviewsTelehealth vs in-person prescribing — what worked for you? Page 2

Telehealth vs in-person prescribing — what worked for you?

tyler_CSCS Tue, Nov 12, 2024 at 10:08 AM 14 replies 1,866 viewsPage 2 of 3
amsterdam_pete
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Netherlands
Nov 12, 2024 at 3:53 PM#6
Dr.SurgeonPGH said:
Insurance coverage hack for cost and coverage: if your insurance denies brand Wegovy/Ozempic, consider these alternatives: Prior authorization appeal…

This is where I part company with the consensus forming above. The affordability discussion here usually stops at individual tactics. At list price this class is out of reach for most of the people who would benefit, and no amount of appeal strategy changes that — it is a pricing problem wearing a paperwork costume.

8 3JakeSmashed95, NauseaFreeNow, SteveThurs and 5 others
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NicoleRaleigh
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Raleigh, NC
Nov 12, 2024 at 6:08 PM#7
tyler_CSCS said:
Denied on prior authorisation twice, approved on the third attempt after a peer-to-peer, and the only thing that changed was who was doing the…
tyler_CSCS said:
...compounded vs brand cost and coverage...

This debate comes up weekly and I think both sides have valid points:

Pro-brand: FDA-approved, manufacturing standards guaranteed, clinical trial data directly applicable

Pro-compounded: 10x cost savings, same active molecule, independent testing available, accessibility

My position: if you can afford brand or have insurance coverage, that's the gold standard. If not, properly tested compounded from a 503B pharmacy is a reasonable alternative. Neither side should shame the other.

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Dr.GastroMayo
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Mayo Clinic, MN
Nov 12, 2024 at 8:24 PM#8
amsterdam_pete said:
The affordability discussion here usually stops at individual tactics.
amsterdam_pete said:
...regarding the discontinuation data for cost and coverage...

I want to reframe the discontinuation narrative. We don't say "insulin fails because blood sugar rises when you stop it." We don't say "antihypertensives fail because BP goes up without them."

Why do we apply different logic to anti-obesity medications? The answer is stigma. We still, unconsciously, believe obesity is about willpower rather than biology. The discontinuation data actually PROVES it's a chronic biological condition requiring ongoing treatment.

This reframing isn't semantic — it has implications for insurance coverage, treatment duration, and patient expectations.

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james_edin
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Sep 2024
Edinburgh, UK
Nov 12, 2024 at 10:40 PM#9

One thing that is still open after RickReta_CO’s answer:

Was that from a primary source or from a summary of one?

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tyler_CSCS
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Phoenix, AZ
Nov 13, 2024 at 9:31 AM#10

OP back with an update, since a thread like this is useless without one.

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

Last edited: Nov 13, 2024 at 11:31 AM
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