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.
Numbers rather than impressions, if you have them.
nick_newbie 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…
Financial impact of cost and coverage weight loss beyond medication cost:
- Groceries: SAVED $200/month (eating less)
- Restaurants: SAVED $190/month (fewer meals out)
- Alcohol: SAVED $140/month (stopped drinking)
- Life insurance: Premium REDUCED by $30/month (lower BMI)
- Copays: SAVED $60/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.
TrialNerd_Beth said:Financial impact of cost and coverage weight loss beyond medication cost: Groceries: SAVED $200/month (eating less) Restaurants: SAVED $190/month…
TrialNerd_Beth said:...regarding the discontinuation data for cost and coverage...
I want to reframe the discontinuation narrative. We don't say "insulin fails because blood sugar rises when you stop it." We don't say "antihypertensives fail because BP goes up without them."
Why do we apply different logic to anti-obesity medications? The answer is stigma. We still, unconsciously, believe obesity is about willpower rather than biology. The discontinuation data actually PROVES it's a chronic biological condition requiring ongoing treatment.
This reframing isn't semantic — it has implications for insurance coverage, treatment duration, and patient expectations.
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Browse GL Biochemnick_newbie 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.
Clinical perspective, offered as context rather than as advice.
Insurance update relevant to cost and coverage: I just got my prior auth approved through Anthem after 2 attempts.
What finally worked: a letter from my endocrinologist documenting BMI history (>3 years), failed diet attempts, comorbidities (T2DM + hypertension), and referencing the SELECT 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.