SarahChen_PharmD said:

Financial impact of cost and coverage weight loss beyond medication cost: Groceries: SAVED $203/month (eating less) Restaurants: SAVED $213/month…

I read this differently from SarahChen_PharmD, on substance rather than tone. 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.

SaraMom3 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 Aetna after 2 attempts.

What finally worked: a letter from my endocrinologist documenting BMI history (>3 years), failed diet attempts, comorbidities (T2DM + hypertension), and referencing the SELECT 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.

Dr.RaviCardio said:

The affordability discussion here usually stops at individual tactics.

Telehealth prescriber review for cost and coverage: I've used 2 different telehealth platforms to get my GLP-1 prescription. Comparison:

I settled on the one that required labs — it shows they care about safety, not just prescribing volume.

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

What did you change at the same time, and can you separate the two now?

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.