Cheapest place to get sema right now? Price keeps going up — March 2026

PurityPaulOR said:

Insurance update relevant to cost and coverage: I just got my prior auth approved through Anthem after 1 attempts.

Pushing back on PurityPaulOR here. 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.

NurseAsh_DET 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 $268/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 $68/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.

amsterdam_pete said:

The affordability discussion here usually stops at individual tactics.

amsterdam_pete 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.

A narrower follow-up, since the general answer is now clear:

How would you tell the difference between that and the alternative explanation?

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

Follow-up — getting the denial reason in writing was the step that mattered. It named the criterion, and the criterion was a document I already had.