Dr.SportsMedIN said:

Financial impact of cost and coverage weight loss beyond medication cost: Groceries: SAVED $266/month (eating less) Restaurants: SAVED $176/month…

I read this differently from Dr.SportsMedIN, 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.

InsuranceTom 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…

Insurance update relevant to cost and coverage: I just got my prior auth approved through UnitedHealthcare after 3 attempts.

What finally worked: a letter from my endocrinologist documenting BMI history (>3 years), failed diet attempts, comorbidities (sleep apnea + prediabetes), and referencing the SELECT trial data.

If your PA keeps getting denied, don't give up. Request a peer-to-peer review between your doctor and the insurance medical director. That's what finally broke through for me.

Dr.SleepRoch said:

The affordability discussion here usually stops at individual tactics.

My insurance denied my PA related to cost and coverage. Has anyone successfully appealed? I'm considering going compounded instead.

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

What did you change at the same time, and can you separate the two now?

OP back with an update, since a thread like this is useless without one.

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.