Dr.RaviCardio 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.

HPLC_Greg said:

Agreed, and the enforcement dates were staggered by category — 503A first, 503B a few weeks later — because outsourcing facilities have manufactured…

Thank you for spelling out the reasoning rather than just the conclusion. Sending this to two other people who asked me the same thing last week.

Dr.RaviCardio said:

Denials are usually procedural rather than clinical, and the order that works reflects that.

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.

Worth separating that from cost and coverage, which this thread keeps folding into the same question. They behave differently and the advice does not transfer.

If somebody has the primary source to hand I would rather cite it than paraphrase it.

rachel_ABQ said:

Two pharmacies quoted me last year, one describing itself as 503A and one as 503B, and I assumed 503B just meant bigger until both stopped within…

Compounded has been just as effective for me. If compounded supply is the concern, the COA from my 503B pharmacy shows 99.1% purity. Verified by Janoshik.

Moderator note: good thread. Keeping it here rather than moving it, because the question is general enough to be useful.