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.
So the question, as narrowly as I can put it: what actually works on a prior-authorisation denial, as opposed to the list of things that sound like they should work.
Happy to be told the question itself is wrong.
TomFromTexas 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…
My insurance denied my PA related to cost and coverage. Has anyone successfully appealed? I'm considering going compounded instead.
MikeFit_NJ said:My insurance denied my PA related to cost and coverage.
MikeFit_NJ 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.
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Browse GL BiochemTomFromTexas 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…
Adding a me-too, because a thread of one person's experience is not much use. The detail I would add is minor and it is already implied above.
Clinical perspective, offered as context rather than as advice.
Financial impact of cost and coverage weight loss beyond medication cost:
- Groceries: SAVED $271/month (eating less)
- Restaurants: SAVED $181/month (fewer meals out)
- Alcohol: SAVED $131/month (stopped drinking)
- Life insurance: Premium REDUCED by $41/month (lower BMI)
- Copays: SAVED $61/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.