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.
If the honest answer is that nobody knows, that is a useful answer and I would rather have it.
SkepticalSean 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…
SkepticalSean 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.
TirzTom said:SkepticalSean said: ...regarding the discontinuation data for cost and coverage...
Insurance update relevant to cost and coverage: I just got my prior auth approved through Anthem after 3 attempts.
What finally worked: a letter from my endocrinologist documenting BMI history (>3 years), failed diet attempts, comorbidities (sleep apnea + prediabetes), 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.
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View ResultsSkepticalSean 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…
This matches mine closely enough to be worth saying so out loud.
From the other side of the consultation, briefly.
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 ($134/month)
- Canadian pharmacy (requires prescription, ~40-60% savings)
Don't let cost prevent access to effective treatment. There are options at every price point.