Sema prices are all over the place — 6 month update

EndoResFellow said:

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

EndoResFellow 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.

amy_econ_NJ said:

JessicaH_TX said: ...my insurance denied cost and coverage coverage because...

This answered a question I did not know how to ask. I will report back once I have actually tried it.

EndoResFellow said:

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

Telehealth prescriber review for cost and coverage: I've used 2 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.

SteveThurs 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…

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

• Groceries: SAVED $201/month (eating less)
• Restaurants: SAVED $191/month (fewer meals out)
• Alcohol: SAVED $141/month (stopped drinking)
• Life insurance: Premium REDUCED by $31/month (lower BMI)
• Copays: SAVED $61/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.

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