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.
The bit I cannot resolve on my own is what actually works on a prior-authorisation denial, as opposed to the list of things that sound like they should work.
I have searched first, so if this is covered somewhere point me at it and I will read it.
LarryQC_SD 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…
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 STEP 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.
Dr.PeteFamMed said:Insurance update relevant to cost and coverage: I just got my prior auth approved through Aetna after 2 attempts.
Telehealth prescriber review for cost and coverage: I've used 3 different telehealth platforms to get my GLP-1 prescription. Comparison:
| Feature | Platform A | Platform B | Platform C |
|---|---|---|---|
| Initial Consult | $55 | $85 | $0 |
| Monthly Follow-up | $35 | Included | $55 |
| Prescription Speed | Same day | 24-48 hours | Same day |
| Lab Monitoring | Required | Optional | Required |
I settled on the one that required labs — it shows they care about safety, not just prescribing volume.
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Browse GL BiochemLarryQC_SD 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…
Can confirm. Same sequence, different timescale. Nothing to add that would improve it.
Clinical perspective, offered as context rather than as advice.
Financial impact of cost and coverage weight loss beyond medication cost:
- Groceries: SAVED $274/month (eating less)
- Restaurants: SAVED $184/month (fewer meals out)
- Alcohol: SAVED $134/month (stopped drinking)
- Life insurance: Premium REDUCED by $44/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.