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ForumsInsurance & AccessMy insurance FINALLY approved it - here is exactly what I did — what worked for you? Page 3

My insurance FINALLY approved it - here is exactly what I did — what worked for you?

PedsEndoPhilly Sun, Dec 28, 2025 at 12:12 PM 15 replies 985 viewsPage 3 of 3
jennifer_SEA
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Nov 2024
Seattle, WA
Dec 29, 2025 at 3:08 PM#11
MASHdoc_SA said:
Financial impact of cost and coverage weight loss beyond medication cost: Groceries: SAVED $253/month (eating less) Restaurants: SAVED $223/month…

Thank you — that is the clearest version of this I have read, and I have read a lot of them.

11 9lucas_SP_BR, lisa_labSD, adam_van and 8 others
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Dr.PainCLE
Senior Member
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Mar 2024
Cleveland, OH
Dec 29, 2025 at 11:46 PM#12

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 ($120/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.

12 10tane_welly, Dr.PathRoch, mona_PHX and 9 others
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KevinCompounds
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Nevada
Dec 30, 2025 at 8:23 AM#13
Dr.LeslieOBGYN said:
raj_cambridge said: ...regarding the discontinuation data for cost and coverage...

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.

13 11MikeKY_noInsulin, Dr.RaviCardio, jennifer_SEA and 10 others
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Dr.PulmRoch
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Rochester, MN
Dec 30, 2025 at 5:00 PM#14
PedsEndoPhilly said:
Denials are usually procedural rather than clinical, and the order that works reflects that.

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

14 12DebRD_ATL, KristenIndy, MarkLI_maint and 11 others
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Admin
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Dec 31, 2025 at 1:37 AM#15

Moderator note: leaving this open. It is being argued well and the disagreement is the useful part. Thread quality here is what the rules are for. Keep it up.

15 13PeptideSynthNJ, Dr.KarenChen, Dr.NateNeph and 12 others
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