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.
Not looking for reassurance. Looking for the part I have got wrong.
marcus_mpls 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…
Insurance update relevant to cost and coverage: I just got my prior auth approved through Cigna 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 STEP 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.
kate.chem said:Insurance update relevant to cost and coverage: I just got my prior auth approved through Cigna after 3 attempts.
Financial impact of cost and coverage weight loss beyond medication cost:
- Groceries: SAVED $208/month (eating less)
- Restaurants: SAVED $178/month (fewer meals out)
- Alcohol: SAVED $128/month (stopped drinking)
- Life insurance: Premium REDUCED by $38/month (lower BMI)
- Copays: SAVED $68/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.
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Browse GL Biochemmarcus_mpls 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…
Same experience, arrived at from the opposite direction. Posting only so the count is not one.
From the other side of the consultation, briefly.
marcus_mpls 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.