VendorMark said:

Financial impact of cost and coverage weight loss beyond medication cost: Groceries: SAVED $217/month (eating less) Restaurants: SAVED $187/month…

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.

nick_SD_fit 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 Anthem after 3 attempts.

What finally worked: a letter from my endocrinologist documenting BMI history (>3 years), failed diet attempts, comorbidities (sleep apnea + prediabetes), 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.

BenResearch_OR 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 LabKate — and this may be the naive question:

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

Reporting back.

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.