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.
What I am trying to establish 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.
marco_milano 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…
My insurance denied my PA related to cost and coverage. Has anyone successfully appealed? I'm considering going compounded instead.
JennaRN said:My insurance denied my PA related to cost and coverage.
Insurance update relevant to cost and coverage: I just got my prior auth approved through UnitedHealthcare after 2 attempts.
What finally worked: a letter from my endocrinologist documenting BMI history (>3 years), failed diet attempts, comorbidities (T2DM + hypertension), 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.
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View Resultsmarco_milano 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…
Can confirm. Same sequence, different timescale.
Clinical perspective, offered as context rather than as advice.
Insurance coverage hack for cost and coverage: if your insurance denies brand Wegovy/Ozempic, consider these alternatives:
Don't let cost prevent access to effective treatment. There are options at every price point.