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.
What I actually want to know is what actually works on a prior-authorisation denial, as opposed to the list of things that sound like they should work.
Tell me what I have not thought of.
mike_nyc 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…
My insurance denied my PA related to cost and coverage. Has anyone successfully appealed? I'm considering going compounded instead.
Dr.GastroMayo said:My insurance denied my PA related to cost and coverage.
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 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.
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Browse GL Biochemmike_nyc 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.
Adding the clinical framing, because it changes how the question reads.
Financial impact of cost and coverage weight loss beyond medication cost:
- Groceries: SAVED $282/month (eating less)
- Restaurants: SAVED $172/month (fewer meals out)
- Alcohol: SAVED $122/month (stopped drinking)
- Life insurance: Premium REDUCED by $32/month (lower BMI)
- Copays: SAVED $62/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.