anders_CPH said:

My insurance denied my PA related to cost and coverage.

This is where I part company with the consensus forming above. 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.

tyler_CSCS 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…

tyler_CSCS 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.

amsterdam_pete said:

The affordability discussion here usually stops at individual tactics.

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

• Groceries: SAVED $264/month (eating less)
• Restaurants: SAVED $174/month (fewer meals out)
• Alcohol: SAVED $124/month (stopped drinking)
• Life insurance: Premium REDUCED by $34/month (lower BMI)
• Copays: SAVED $74/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.

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

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

Closing the loop on my own question.

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