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ForumsInsurance & AccessHow is this not covered but my coworker gets Viagra no questions asked

How is this not covered but my coworker gets Viagra no questions asked

TomFromTexas Sat, May 9, 2026 at 11:17 AM 31 replies 862 viewsPage 1 of 7
TomFromTexas
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May 2024
Austin, TX
May 9, 2026 at 11:17 AM#1

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 talking.

The question I want answered is what actually works on a prior-authorisation denial, as opposed to the list of things that sound like they should work.

Not looking for reassurance. Looking for the part I have got wrong.

37 7PharmD_Rodriguez, julia.endo, JessicaM_2024 and 34 others
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PeptideChemSF
Senior Member
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9,012
Jan 2024
San Francisco, CA
May 9, 2026 at 11:42 AM#2
TomFromTexas 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 Cigna after 2 attempts.

What finally worked: a letter from my endocrinologist documenting BMI history (>3 years), failed diet attempts, comorbidities (T2DM + hypertension), and referencing the STEP 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.

Last edited: May 9, 2026 at 3:42 PM
36 6dave_SLC, FDA_TrackerJim, ricardo_MIA and 33 others
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Dr.DermMIA
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May 2024
Miami, FL
May 9, 2026 at 12:06 PM#3
PeptideChemSF said:
Insurance update relevant to cost and coverage: I just got my prior auth approved through Cigna after 2 attempts.

Telehealth prescriber review for cost and coverage: I've used 3 different telehealth platforms to get my GLP-1 prescription. Comparison:

FeaturePlatform APlatform BPlatform C
Initial Consult$58$88$0
Monthly Follow-up$38Included$58
Prescription SpeedSame day24-48 hoursSame day
Lab MonitoringRequiredOptionalRequired

I settled on the one that required labs — it shows they care about safety, not just prescribing volume.

Last edited: May 9, 2026 at 2:06 PM
35 5A1cHero_PHX, Dr.RenalNash, LipidDoc_ATL and 32 others
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quinn_sf
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Jun 2024
San Francisco, CA
May 9, 2026 at 12:31 PM#4
TomFromTexas 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…

This is my experience too, for whatever a second data point is worth. Nothing to add that would improve it.

34 4andrew_nyc, Dr.EndoEP, GraceAZ_72 and 31 others
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LipidDoc_ATL
Senior Member
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Apr 2024
Atlanta, GA
May 9, 2026 at 2:50 PM#5

From the other side of the consultation, briefly.

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

33 3KristenIndy, MarkLI_maint, Dr.PeteFamMed and 30 others
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