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ForumsVendor ReviewsSema prices are all over the place — looking for input

Sema prices are all over the place — looking for input

RunnerRach Sun, Dec 29, 2024 at 5:47 AM 16 replies 1,709 viewsPage 1 of 4
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RunnerRach
Member
467
2,123
Aug 2024
Boston, MA
Dec 29, 2024 at 5:47 AM#1

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 would genuinely help is knowing 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.

32 2BenResearch_OR, MikeKY_noInsulin, Dr.RaviCardio and 29 others
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LibrarianMeg
Senior Member
1,678
7,890
Mar 2024
Baltimore, MD
Dec 29, 2024 at 6:05 AM#2
RunnerRach 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…

Financial impact of cost and coverage weight loss beyond medication cost:

  • Groceries: SAVED $220/month (eating less)
  • Restaurants: SAVED $190/month (fewer meals out)
  • Alcohol: SAVED $140/month (stopped drinking)
  • Life insurance: Premium REDUCED by $30/month (lower BMI)
  • Copays: SAVED $60/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.

31 1PharmD_Rodriguez, julia.endo, JessicaM_2024 and 28 others
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Dr.PeteFamMed
Senior Member
2,012
9,234
Jan 2024
Minneapolis, MN
Dec 29, 2024 at 6:23 AM#3
LibrarianMeg said:
Financial impact of cost and coverage weight loss beyond medication cost: Groceries: SAVED $220/month (eating less) Restaurants: SAVED $190/month…
LibrarianMeg 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.

Last edited: Dec 29, 2024 at 7:23 AM
30 0LindaRN_retired, tommy_boulder, hyun_seoul and 27 others
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Dr.DermMIA
Member
456
2,123
May 2024
Miami, FL
Dec 29, 2024 at 6:41 AM#4
RunnerRach 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…

Mine went the same way, slower.

Last edited: Dec 29, 2024 at 8:41 AM
29 24PeptideChemSF, A1cHero_PHX, Dr.RenalNash and 26 others
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Dr.EM_Chicago
Member
567
2,567
May 2024
Chicago, IL
Dec 29, 2024 at 8:18 AM#5

From the other side of the consultation, briefly.

RunnerRach 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.

Last edited: Dec 29, 2024 at 12:18 PM
28 23lisa_labSD, adam_van, Dr.SurgeonPGH and 25 others
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