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.
So the question, as narrowly as I can put it: what actually works on a prior-authorisation denial, as opposed to the list of things that sound like they should work.
If the honest answer is that nobody knows, that is a useful answer and I would rather have it.
This one has a reasonably settled answer, so here it is. Albumin binding above 99% is the whole reason weekly dosing works, and it is also why the trough matters more than the peak. People who dose late are not losing a peak, they are letting the trough fall, and the appetite effect tracks the trough.
BenResearch_OR said:Albumin binding above 99% is the whole reason weekly dosing works, and it is also why the trough matters more than the peak.
All true, with one condition: that curve is for people who reached the dose on schedule. Anyone who slowed the ladder for tolerability is on a different, flatter curve, and comparing yourself with the published mean will make you feel like a non-responder when you are not.
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Shop Reference Standardsanders_CPH 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…
Agreed, though "tolerable" needs defining. A dose you tolerate by eating almost nothing is not tolerated, it is being paid for somewhere else — usually in lean mass, sometimes in adherence three months later.
Correct me if the detail matters more than I have assumed.
From the other side of the consultation, briefly.
Insurance update relevant to cost and coverage: I just got my prior auth approved through Aetna 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 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.