Dr.GutHealth said:

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

I read this differently from Dr.GutHealth, 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.

kevin_tulsa said:

Denied on prior authorisation twice, approved on the third attempt after a peer-to-peer, and the only thing that changed was who was doing the…

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 ($116/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.

kate.chem said:

The affordability discussion here usually stops at individual tactics.

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

Following on from MikeKY_noInsulin — and this may be the naive question:

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.