Short answer first, then the reasoning. Denials are usually procedural rather than clinical, and the order that works reflects that. Get the denial reason in writing, because it names the criterion you failed. Then supply the documentation that criterion asks for — usually documented BMI with a comorbidity, or a failed prior therapy. Then appeal, and ask for a peer-to-peer review, because a prescriber talking to a reviewing clinician resolves a large fraction of denials that written appeals do not. Manufacturer copay assistance is separate and applies mainly to commercial insurance, and patient assistance programmes are means-tested rather than a discount.

PurityPaulOR said:

Denials are usually procedural rather than clinical, and the order that works reflects that.

Agreed, and coverage criteria are plan-specific rather than insurer-specific. Two people with the same insurer and different employers have different rules, which is why "my insurer covers it" is not transferable information.

tom_AK said:

One order arrived in nine days, one was held at the border for a fortnight, and one came back with a seizure notice.

Same experience, arrived at from the opposite direction. Posting only so the count is not one.

Adding the clinical framing, because it changes how the question reads.

My experience ordering cross-border ordering internationally: I've ordered from a UK pharmacy. Customs can be hit or miss.

Shipping time: 7-14 days
Customs clearance: smooth, no issues
Quality: Janoshik tested at 99.2% purity

International ordering adds complexity but can save 60-80% compared to US prices. Research your country's import laws first.