LindaRN_retired said:SarahChen_PharmD said: ...but the FDA says semaglutide...
Agreed, and coverage criteria are plan-specific rather than insurer-specific. Two people with the same insurer and different employers have different rules, which is why "my insurer covers it" is not transferable information.
Worth separating that from cost and coverage, which this thread keeps folding into the same question. They behave differently and the advice does not transfer.
That is the short version; the long version is somebody else's post.
lucas_SP_BR said:Worth stating the units and the reference range whenever you post a number here.
Coming at lucas_SP_BR’s question from a different direction. Denials are usually procedural rather than clinical, and the order that works reflects that. Get the denial reason in writing, because it names the criterion you failed. Then supply the documentation that criterion asks for — usually documented BMI with a comorbidity, or a failed prior therapy. Then appeal, and ask for a peer-to-peer review, because a prescriber talking to a reviewing clinician resolves a large fraction of denials that written appeals do not. Manufacturer copay assistance is separate and applies mainly to commercial insurance, and patient assistance programmes are means-tested rather than a discount.
Worth separating that from cost and coverage, which this thread keeps folding into the same question. They behave differently and the advice does not transfer.
Adding the numbers, since they settle part of this. Practical: whatever you change, write down the date and the reason. In three months the reason is what you will have forgotten, and the reason is what makes the record worth having.
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View ResultsOne thing that is still open after lucas_SP_BR’s answer:
What the dose-response curve actually looks like above 1.7mg, because the trial means hide how few people account for the extra loss?
Moderator note: leaving this open. It is being argued well and the disagreement is the useful part.