Dr.SportsMedIN 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.

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

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

Dr.RaviCardio said:

My insurance denied my PA related to cost and coverage.

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 STEP 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.

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.

EndoResFellow said:

Insurance update relevant to cost and coverage: I just got my prior auth approved through Aetna after 2 attempts.

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.