Denied on prior authorisation twice, approved on the third attempt after a peer-to-peer, and the only thing that changed was who was doing the talking.
The bit I cannot resolve on my own is what actually works on a prior-authorisation denial, as opposed to the list of things that sound like they should work.
Happy to be told the question itself is wrong.
Dr.DermMIA said:Denied on prior authorisation twice, approved on the third attempt after a peer-to-peer, and the only thing that changed was who was doing the…
My insurance denied my PA related to cost and coverage. Has anyone successfully appealed? I'm considering going compounded instead.
COA_Karl said:My insurance denied my PA related to cost and coverage.
Financial impact of cost and coverage weight loss beyond medication cost:
- Groceries: SAVED $229/month (eating less)
- Restaurants: SAVED $199/month (fewer meals out)
- Alcohol: SAVED $149/month (stopped drinking)
- Life insurance: Premium REDUCED by $39/month (lower BMI)
- Copays: SAVED $59/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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View ResultsDr.DermMIA said:Denied on prior authorisation twice, approved on the third attempt after a peer-to-peer, and the only thing that changed was who was doing the…
Same pattern here, and in the same order. Posting only so the count is not one.
Adding the clinical framing, because it changes how the question reads.
Dr.DermMIA 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.