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Evidence-based GLP-1 & peptide discussion since 2023
ForumsSemaglutide (Ozempic / Wegovy)Insurance denied me AGAIN - I am so frustrated — 12 month update Page 2

Insurance denied me AGAIN - I am so frustrated — 12 month update

NeuroNate Tue, Jan 9, 2024 at 10:43 AM 9 replies 2,226 viewsPage 2 of 2
BethLabQueen
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Jan 10, 2024 at 12:14 AM#6
anders_CPH said:
NeuroNate said: ...regarding the discontinuation data for cost and coverage...

Pushing back on anders_CPH here. 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.

7 2maya_sedona, stefan_berlin, Dr.EM_Chicago and 4 others
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TirzTom
Senior Member
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Florida
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Jan 10, 2024 at 5:36 AM#7
NeuroNate 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…

Telehealth prescriber review for cost and coverage: I've used 4 different telehealth platforms to get my GLP-1 prescription. Comparison:

FeaturePlatform APlatform BPlatform C
Initial Consult$68$88$0
Monthly Follow-up$38Included$53
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.

6 1tom_AK, josh_phd_bmore, roxy_nash and 3 others
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EndoResFellow
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Sep 2024
Baltimore, MD
Jan 10, 2024 at 10:58 AM#8
BethLabQueen said:
The affordability discussion here usually stops at individual tactics.
BethLabQueen 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.

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tony_orlando
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Nov 2024
Orlando, FL
Jan 10, 2024 at 4:20 PM#9

A narrower follow-up, since the general answer is now clear:

Did your prescriber agree with that reading, and if not what was their objection?

Last edited: Jan 10, 2024 at 5:20 PM
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NeuroNate
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Dec 2023
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Jan 11, 2024 at 6:06 PM#10

Reporting back.

Update: approved on the third attempt after a peer-to-peer. Nothing about my case changed; only who was doing the talking.

2 0Dr.NephBHM_UK, kim_atl_prep
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