VA healthcare GLP-1 access — veteran members share experiences

Dr.SurgeonPGH said:

Financial impact of cost and coverage weight loss beyond medication cost: Groceries: SAVED $280/month (eating less) Restaurants: SAVED $150/month…

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.

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…

Insurance update relevant to cost and coverage: I just got my prior auth approved through Anthem after 4 attempts.

What finally worked: a letter from my endocrinologist documenting BMI history (>3 years), failed diet attempts, comorbidities (NAFLD + metabolic syndrome), and referencing the SURMOUNT 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.

TirzTom said:

The affordability discussion here usually stops at individual tactics.

My insurance denied my PA related to cost and coverage. Has anyone successfully appealed? I'm considering going compounded instead.

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

What did you change at the same time, and can you separate the two now?

Reporting back.

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.