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ForumsInternationalSwitzerland BAG coverage — anyone have experience?

Switzerland BAG coverage — anyone have experience?

hank_denver Mon, Jul 22, 2024 at 6:40 AM 47 replies 3,019 viewsPage 1 of 10
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hank_denver
Member
278
1,234
Sep 2024
Denver, CO
Jul 22, 2024 at 6:40 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.

The narrow version of the question is what actually works on a prior-authorisation denial, as opposed to the list of things that sound like they should work.

Tell me what I have not thought of.

10 13ingrid_STO, pete_nash, hank_denver and 7 others
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amsterdam_pete
Senior Member
1,567
6,789
Feb 2024
Netherlands
Jul 22, 2024 at 7:03 AM#2
hank_denver 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.

11 14ZaraB_AL, JakeSmashed95, NauseaFreeNow and 8 others
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kim_atl_prep
Member
312
1,345
Aug 2024
Atlanta, GA
Jul 22, 2024 at 7:26 AM#3
amsterdam_pete said:
My insurance denied my PA related to cost and coverage.

Insurance coverage hack for cost and coverage: if your insurance denies brand Wegovy/Ozempic, consider these alternatives:

  1. Prior authorization appeal with peer-to-peer review
  2. Manufacturer copay card (for commercial insurance)
  3. Patient assistance programs (Novo Nordisk, Eli Lilly)
  4. Compounded medication from a 503B pharmacy ($145/month)
  5. Canadian pharmacy (requires prescription, ~40-60% savings)

Don't let cost prevent access to effective treatment. There are options at every price point.

12 15RegAffairsDC, BiostatsBrad, PeptideSynthNJ and 9 others
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tane_welly
Member
234
1,123
Sep 2024
Wellington, NZ
Jul 22, 2024 at 7:49 AM#4
hank_denver 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…

Second this. I had assumed I was the exception until I read this.

13 16marco_milano, pam_columbus, nick_SD_fit and 10 others
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PharmD_Rodriguez
Senior Member
3,456
14,567
Jan 2024
Miami, FL
Jul 22, 2024 at 9:55 AM#5

From the other side of the consultation, briefly.

Telehealth prescriber review for cost and coverage: I've used 3 different telehealth platforms to get my GLP-1 prescription. Comparison:

FeaturePlatform APlatform BPlatform C
Initial Consult$61$81$0
Monthly Follow-up$31Included$61
Prescription SpeedSame day24-48 hoursSame day
Lab MonitoringRequiredOptionalRequired

I settled on the one that required labs — it shows they care about safety, not just prescribing volume.

14 17MeganSA_TX, LarryQC_SD, wanda_boise and 11 others
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