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 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.
Not looking for reassurance. Looking for the part I have got wrong.
InsuranceTom 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…
Insurance update relevant to cost and coverage: I just got my prior auth approved through Cigna 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 SURMOUNT 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.
julia.endo said:Insurance update relevant to cost and coverage: I just got my prior auth approved through Cigna after 1 attempts.
My insurance denied my PA related to cost and coverage. Has anyone successfully appealed? I'm considering going compounded instead.
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Browse GL BiochemInsuranceTom 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…
Adding a me-too, because a thread of one person's experience is not much use.
Adding the clinical framing, because it changes how the question reads.
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 ($144/month)
- Canadian pharmacy (requires prescription, ~40-60% savings)
Don't let cost prevent access to effective treatment. There are options at every price point.