I've done two internal appeals. Hadn't considered the external appeal route — I'll ask about that. The prediabetes angle is interesting too. My fasting glucose has been consistently 110-120 and my doctor has been watching it closely. yeah the savings card doesn't work because my insurance has a blanket exclusion. I looked into it already. 😞 Going to pursue both the external appeal AND the PAP application simultaneously. No reason I can't do both right?

Absolutely do both simultaneously. There's no rule against it. If the insurance appeal comes through first, great — you'll have more sustainable long-term coverage. If the PAP comes through first, you're covered while you continue fighting insurance. Pro tip for the PAP application: have your doctor write a detailed letter of medical necessity to include with the application. Even though it's not technically required, I've found applications with a doctor's letter explaining the clinical rationale get processed faster and have higher approval rates. Include: your BMI history, comorbidities (prediabetes, any others?), failed interventions, and why tirzepatide specifically is needed vs. alternatives.

Update for anyone following this thread: I submitted both the external appeal and the Lilly Cares application last week. Will report back on timelines and outcomes. Thanks everyone for the guidance — this community is amazing. 🙏