InsuranceTom 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…

Insurance update relevant to cost and coverage: I just got my prior auth approved through Cigna 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 SURMOUNT 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.

julia.endo said:

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

My insurance denied my PA related to cost and coverage. Has anyone successfully appealed? I'm considering going compounded instead.

InsuranceTom 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…

Adding a me-too, because a thread of one person's experience is not much use.

Adding the clinical framing, because it changes how the question reads.

Insurance coverage hack for cost and coverage: if your insurance denies brand Wegovy/Ozempic, consider these alternatives:

1. Prior authorization appeal with peer-to-peer review
2. Manufacturer copay card (for commercial insurance)
3. Patient assistance programs (Novo Nordisk, Eli Lilly)
4. Compounded medication from a 503B pharmacy ($144/month)
5. Canadian pharmacy (requires prescription, ~40-60% savings)

Don't let cost prevent access to effective treatment. There are options at every price point.