Insurance said NO again and I am about to lose it

VendorMark said:

JenPlateau said: ...compounded vs brand cost and coverage...

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.

JenPlateau 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 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.

DanielChem_CHI said:

The affordability discussion here usually stops at individual tactics.

Insurance coverage hack for cost and coverage: if your insurance denies brand Wegovy/Ozempic, consider these alternatives:

1. Prior authorization appeal with peer-to-peer review
2. Manufacturer copay card (for commercial insurance)
3. Patient assistance programs (Novo Nordisk, Eli Lilly)
4. Compounded medication from a 503B pharmacy ($137/month)
5. Canadian pharmacy (requires prescription, ~40-60% savings)

Don't let cost prevent access to effective treatment. There are options at every price point.

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

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

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.