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ForumsInsurance & AccessManufacturer coupon saved me $1000 this month not even kidding — anyone have experience?

Manufacturer coupon saved me $1000 this month not even kidding — anyone have experience?

RunnerRach Mon, Dec 15, 2025 at 1:13 PM 43 replies 1,872 viewsPage 1 of 9
RunnerRach
Member
467
2,123
Aug 2024
Boston, MA
Dec 15, 2025 at 1:13 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.

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.

Happy to be told the question itself is wrong.

2 22BenResearch_OR, MikeKY_noInsulin
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LipidDoc_ATL
Senior Member
1,123
5,678
Apr 2024
Atlanta, GA
Dec 15, 2025 at 1:28 PM#2
RunnerRach 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…

Insurance update relevant to cost and coverage: I just got my prior auth approved through Blue Cross 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 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.

1 21traveltech_sara
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Dr.PulmRoch
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2,345
Jun 2024
Rochester, MN
Dec 15, 2025 at 1:43 PM#3
LipidDoc_ATL said:
Insurance update relevant to cost and coverage: I just got my prior auth approved through Blue Cross after 2 attempts.

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

50 20AttorneyGrant, DebRD_ATL, KristenIndy and 47 others
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robert_kc
Member
289
1,234
Oct 2024
Kansas City, MO
Dec 15, 2025 at 1:58 PM#4
RunnerRach 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…

Same experience, arrived at from the opposite direction. Nothing to add that would improve it.

49 19TomTeleRx, DoseLogDan, SleepFixSam and 46 others
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claudia_zurich
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Jul 2024
Zurich, CH
Dec 15, 2025 at 3:18 PM#5

Adding the clinical framing, because it changes how the question reads.

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 ($140/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.

48 18kevin_tulsa, Dr.PainCLE, mike_mealprep and 45 others
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