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.
What I am after is what actually works on a prior-authorisation denial, as opposed to the list of things that sound like they should work.
Practical detail welcome, however dull — the duller the better.
stefan_berlin 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 Blue Cross after 1 attempts.
What finally worked: a letter from my endocrinologist documenting BMI history (>3 years), failed diet attempts, comorbidities (PCOS + insulin resistance), 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.NateNeph said:Insurance update relevant to cost and coverage: I just got my prior auth approved through Blue Cross after 1 attempts.
Financial impact of cost and coverage weight loss beyond medication cost:
- Groceries: SAVED $213/month (eating less)
- Restaurants: SAVED $203/month (fewer meals out)
- Alcohol: SAVED $153/month (stopped drinking)
- Life insurance: Premium REDUCED by $43/month (lower BMI)
- Copays: SAVED $63/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.
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Browse GL Biochemstefan_berlin 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…
Second this. Nothing to add that would improve it.
From the other side of the consultation, briefly.
stefan_berlin said:...compounded vs brand cost and coverage...
This debate comes up weekly and I think both sides have valid points:
Pro-brand: FDA-approved, manufacturing standards guaranteed, clinical trial data directly applicable
Pro-compounded: 10x cost savings, same active molecule, independent testing available, accessibility
My position: if you can afford brand or have insurance coverage, that's the gold standard. If not, properly tested compounded from a 503B pharmacy is a reasonable alternative. Neither side should shame the other.