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.
The question I want answered 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.
A1cHero_PHX 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.
PeptideChemSF said:My insurance denied my PA related to cost and coverage.
Insurance coverage hack for cost and coverage: if your insurance denies brand Wegovy/Ozempic, consider these alternatives:
- Prior authorization appeal with peer-to-peer review
- Manufacturer copay card (for commercial insurance)
- Patient assistance programs (Novo Nordisk, Eli Lilly)
- Compounded medication from a 503B pharmacy ($116/month)
- Canadian pharmacy (requires prescription, ~40-60% savings)
Don't let cost prevent access to effective treatment. There are options at every price point.
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View ResultsA1cHero_PHX 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…
Second this. The detail I would add is minor and it is already implied above.
From the other side of the consultation, briefly.
Financial impact of cost and coverage weight loss beyond medication cost:
- Groceries: SAVED $245/month (eating less)
- Restaurants: SAVED $195/month (fewer meals out)
- Alcohol: SAVED $145/month (stopped drinking)
- Life insurance: Premium REDUCED by $35/month (lower BMI)
- Copays: SAVED $55/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.