labquiet_amy said:

andrew_nyc said: ...compounded vs brand cost and coverage...

Filing a mild objection. Mild because I might be wrong; an objection because nobody has addressed the case that does not fit. 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.

andrew_nyc 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…

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

Dr.GutHealth said:

The affordability discussion here usually stops at individual tactics.

Financial impact of cost and coverage weight loss beyond medication cost:

• Groceries: SAVED $237/month (eating less)
• Restaurants: SAVED $207/month (fewer meals out)
• Alcohol: SAVED $157/month (stopped drinking)
• Life insurance: Premium REDUCED by $47/month (lower BMI)
• Copays: SAVED $77/month (fewer BP/cholesterol meds)

Net impact after medication cost: approximately BREAKING EVEN. The medication pays for itself through reduced food spending and healthcare costs. This surprised me.

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

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

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.