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.
Numbers rather than impressions, if you have them.
kevin_tulsa 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…
kevin_tulsa 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.
Dr.RaviCardio said:kevin_tulsa said: ...regarding the discontinuation data for cost and coverage...
Insurance update relevant to cost and coverage: I just got my prior auth approved through Aetna after 1 attempts.
What finally worked: a letter from my endocrinologist documenting BMI history (>3 years), failed diet attempts, comorbidities (PCOS + insulin resistance), 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.
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Shop Reference Standardskevin_tulsa 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.
Adding the clinical framing, because it changes how the question reads.
My insurance denied my PA related to cost and coverage. Has anyone successfully appealed? I'm considering going compounded instead.