Dr.ObesityMed said:

jason_paloalto said: ...compounded vs brand cost and coverage...

I read this differently from Dr.ObesityMed, on substance rather than tone. The affordability discussion here usually stops at individual tactics. At list price this class is out of reach for most of the people who would benefit, and no amount of appeal strategy changes that — it is a pricing problem wearing a paperwork costume.

jason_paloalto 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.

LabKate said:

The affordability discussion here usually stops at individual tactics.

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

• Groceries: SAVED $205/month (eating less)
• Restaurants: SAVED $155/month (fewer meals out)
• Alcohol: SAVED $105/month (stopped drinking)
• Life insurance: Premium REDUCED by $35/month (lower BMI)
• Copays: SAVED $65/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.

One thing that is still open after MounjBrad’s answer:

How would you tell the difference between that and the alternative explanation?

Closing the loop on my own question.

Follow-up — getting the denial reason in writing was the step that mattered. It named the criterion, and the criterion was a document I already had.