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ForumsInsurance & Access2026 payer coverage update — GLP-1 formulary changes by insurer Page 5

2026 payer coverage update — GLP-1 formulary changes by insurer

InsuranceTom Mon, Feb 26, 2024 at 4:00 PM 377 replies 33,823 viewsPage 5 of 20
bri_stats
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Mar 3, 2024 at 1:57 PM#21
pete_nash said:
My insurance denied my PA related to cost and coverage.

Adding the part of the answer the thread has not reached. Whatever the answer turns out to be, the method for getting there is the same: state the assumption, do the arithmetic in public, and invite the correction. That is slower than asserting, and it is the only version that survives being wrong.

22 20sarah_nash92, FitDadDave, RunnerRach and 19 others
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Dr.RaviCardio
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Mar 5, 2024 at 8:44 AM#22

One concrete data point for the thread. The boring version of this is the one that works, and the boring version is: measure a baseline, change one variable, wait, measure again under the same conditions. Nobody wants that answer and it is still the answer.

23 21anna.melb_AU, mark_tokyo, hans_munich and 20 others
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HPLC_Greg
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Mar 7, 2024 at 3:30 AM#23

Following on from pete_nash — and this may be the naive question:

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

24 22RetaRick_CA, JenPlateau, SallyK_inj and 21 others
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bbq_ray_KC
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Mar 8, 2024 at 10:15 PM#24
Dr.RaviCardio said:
The boring version of this is the one that works, and the boring version is: measure a baseline, change one variable, wait, measure again under the…

This is where I part company with the consensus forming above. Filing an objection on the n=1 problem. Personal experience is genuine evidence about one person and very weak evidence about anybody else, and this thread keeps promoting the first into the second.

Last edited: Mar 9, 2024 at 12:15 AM
25 23WendyG_ATL, SaraMom3, Dr.MetabolicMD and 22 others
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gary_naperville
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Mar 10, 2024 at 4:59 PM#25
Dr.RaviCardio said:
The boring version of this is the one that works, and the boring version is: measure a baseline, change one variable, wait, measure again under the…

That is right, and it stops being right at the edges. The general case is well behaved; the interesting cases in this thread are all at the boundary where the general case breaks.

26 24RickReta_CO, PharmHunterJen, TomTeleRx and 23 others
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