Prior auth denied for the 3rd time - what am I doing wrong — January 2024

Dr.Martinez said:

Dr.RaviCardio said: ...compounded vs brand cost and coverage...

Thank you — that is the clearest version of this I have read, and I have read a lot of them.

Clinical perspective, offered as context rather than as advice.

Telehealth prescriber review for cost and coverage: I've used 2 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.

Dr.NateNeph said:

LabKate said: ...regarding the discontinuation data for 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 ($146/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.

sarah.morrison said:

Denials are usually procedural rather than clinical, and the order that works reflects that.

Financial impact of cost and coverage weight loss beyond medication cost:

• Groceries: SAVED $264/month (eating less)
• Restaurants: SAVED $194/month (fewer meals out)
• Alcohol: SAVED $144/month (stopped drinking)
• Life insurance: Premium REDUCED by $34/month (lower BMI)
• Copays: SAVED $74/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. Tagging this one for the weekly digest.