Prior auth denied for the 3rd time - what am I doing wrong — my results so far

GenomicsKate said:

My insurance denied my PA related to cost and coverage.

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

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

rachel_ABQ said:

Dr.ObesityMed said: ...my insurance denied cost and coverage coverage because...

Genuinely useful, thank you. I had the facts and not the framework. I will report back once I have actually tried it.

GenomicsKate said:

My insurance denied my PA related to cost and coverage.

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 ($111/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.

PharmD_Rodriguez 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 $259/month (eating less)
• Restaurants: SAVED $189/month (fewer meals out)
• Alcohol: SAVED $139/month (stopped drinking)
• Life insurance: Premium REDUCED by $49/month (lower BMI)
• Copays: SAVED $59/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.

Moderator note: a couple of off-topic posts removed. No action needed from anybody.