Dr.LeslieOBGYN 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.

RickReta_CO said:

Worth adding the genuine exception, because it is real and narrow: a change made for an identified patient where the prescriber determines it produces…

Bookmarking. The distinction being drawn above is the one nobody else makes. I will report back once I have actually tried it.

Dr.LeslieOBGYN said:

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

Filing a mild objection. Mild because I might be wrong; an objection because nobody has addressed the case that does not fit. 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.

I would rather be corrected than agreed with, if it comes to it.

gary_naperville 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…

Price comparison for compounded supply across sources I've used:

I use the 503B option — best balance of quality, cost, and legality. The brand price is insane but insurance can help if you qualify.

Moderator note: a couple of off-topic posts removed.