One thing that is still open after paige_pharma’s answer:

How would you tell the difference between that and the alternative explanation?

josh_phd_bmore said:

Insurance update relevant to cost and coverage: I just got my prior auth approved through Cigna after 4 attempts.

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 ($125/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.

josh_phd_bmore said:

Insurance update relevant to cost and coverage: I just got my prior auth approved through Cigna after 4 attempts.

Fair, and it stops being fair at the extremes. The middle of the range is well understood; the ends are where the honest answer is that nobody knows.

josh_phd_bmore said:

Insurance update relevant to cost and coverage: I just got my prior auth approved through Cigna after 4 attempts.

Thank you — that is the clearest version of this I have read, and I have read a lot of them. Printing the relevant bit and taking it with me.

OP back with an update, since a thread like this is useless without one.

Follow-up — getting the denial reason in writing was the step that mattered. It named the criterion, and the criterion was a document I already had.