This one has a reasonably settled answer, so here it is. 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.

That is the short version; the long version is somebody else's post.

VendorMark 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.

kate.chem said:

Living somewhere the domestic route does not exist, which makes most of the advice on this board inapplicable to me.

Same experience, arrived at from the opposite direction.

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

International shipping tracking for cross-border ordering orders: my experience with customs in the US when ordering from overseas:

Seized and destroyed — had to get a reshipped package.

Tips: always include a copy of your prescription, declare medication properly on customs forms, keep quantities reasonable (personal use = 3 month supply max), and use a vendor who has experience shipping to your country.