stefan_berlin 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 Blue Cross after 1 attempts.

What finally worked: a letter from my endocrinologist documenting BMI history (>3 years), failed diet attempts, comorbidities (PCOS + insulin resistance), and referencing the STEP 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.NateNeph said:

Insurance update relevant to cost and coverage: I just got my prior auth approved through Blue Cross after 1 attempts.

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

• Groceries: SAVED $213/month (eating less)
• Restaurants: SAVED $203/month (fewer meals out)
• Alcohol: SAVED $153/month (stopped drinking)
• Life insurance: Premium REDUCED by $43/month (lower BMI)
• Copays: SAVED $63/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.

stefan_berlin 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…

Second this. Nothing to add that would improve it.

From the other side of the consultation, briefly.

stefan_berlin said:

...compounded vs brand cost and coverage...

This debate comes up weekly and I think both sides have valid points:

Pro-brand: FDA-approved, manufacturing standards guaranteed, clinical trial data directly applicable

Pro-compounded: 10x cost savings, same active molecule, independent testing available, accessibility

My position: if you can afford brand or have insurance coverage, that's the gold standard. If not, properly tested compounded from a 503B pharmacy is a reasonable alternative. Neither side should shame the other.