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ForumsInsurance & AccessBlue Cross Blue Shield — my results so far

Blue Cross Blue Shield — my results so far

mona_PHX Thu, Mar 19, 2026 at 7:53 PM 12 replies 768 viewsPage 1 of 3
mona_PHX
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Dec 2024
Phoenix, AZ
Mar 19, 2026 at 7:53 PM#1

The list price and the price I actually pay differ by a factor of six depending on which of four routes I use, and none of that is transparent from the outside.

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

Happy to be told the question itself is wrong.

37 7RetaRick_CA, JenPlateau, SallyK_inj and 34 others
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VendorMark
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Texas
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Mar 19, 2026 at 8:04 PM#2
mona_PHX said:
The list price and the price I actually pay differ by a factor of six depending on which of four routes I use, and none of that is transparent from…

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$67$87$0
Monthly Follow-up$37Included$52
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: Mar 19, 2026 at 10:04 PM
36 6KristenIndy, MarkLI_maint, Dr.PeteFamMed and 33 others
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KevinCompounds
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Mar 19, 2026 at 8:15 PM#3
VendorMark said:
Telehealth prescriber review for cost and coverage: I've used 3 different telehealth platforms to get my GLP-1 prescription.

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 ($125/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.

Last edited: Mar 19, 2026 at 10:15 PM
35 5MikeKY_noInsulin, Dr.RaviCardio, jennifer_SEA and 32 others
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denise_HTX
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Jan 2025
Houston, TX
Mar 19, 2026 at 8:26 PM#4
mona_PHX said:
The list price and the price I actually pay differ by a factor of six depending on which of four routes I use, and none of that is transparent from…

Can confirm. Same sequence, different timescale. I had assumed I was the exception until I read this.

34 4KevinCompounds, TirzTom, TrialTracker_MD and 31 others
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Dr.PeteFamMed
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Minneapolis, MN
Mar 19, 2026 at 9:26 PM#5

Clinical perspective, offered as context rather than as advice.

mona_PHX said:
...regarding the discontinuation data for cost and coverage...

I want to reframe the discontinuation narrative. We don't say "insulin fails because blood sugar rises when you stop it." We don't say "antihypertensives fail because BP goes up without them."

Why do we apply different logic to anti-obesity medications? The answer is stigma. We still, unconsciously, believe obesity is about willpower rather than biology. The discontinuation data actually PROVES it's a chronic biological condition requiring ongoing treatment.

This reframing isn't semantic — it has implications for insurance coverage, treatment duration, and patient expectations.

Last edited: Mar 19, 2026 at 10:26 PM
33 3FranDenver, Dr.BariatricHTX, LindaRN_retired and 30 others
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