Dr.KarenChen said:

Agreed, and coverage criteria are plan-specific rather than insurer-specific.

This answered a question I did not know how to ask.

Dr.ObesityMed said:

SUSTAIN-6 was the first CVOT to show cardiovascular benefit with semaglutide, relevant to cardiovascular risk.

Filing a mild objection. Mild because I might be wrong; an objection because nobody has addressed the case that does not fit. The affordability discussion here usually stops at individual tactics. At list price this class is out of reach for most of the people who would benefit, and no amount of appeal strategy changes that — it is a pricing problem wearing a paperwork costume.

hank_denver said:

My reason for being on this is cardiovascular rather than cosmetic, which puts me in a small minority in most of these threads.

CRP reduction on cardiovascular risk — this is the lab result that excites me most:

Baseline hsCRP: 8.0 mg/L (high cardiovascular risk)
Month 6 hsCRP: 3.5 mg/L (moderate risk)
Month 12 hsCRP: 0.9 mg/L (low risk)

This level of inflammatory marker reduction is comparable to what you'd see with statin therapy. Combined with the weight loss, my 10-year ASCVD risk score dropped from 15% to 6%. My cardiologist is genuinely impressed.

Moderator note: a couple of off-topic posts removed. Thread quality here is what the rules are for. Keep it up.