Dr.GutHealth said:

The version of this that has an answer is narrower than the version being asked.

Agreeing with Dr.GutHealth, and the qualification matters more than the agreement. Yes, and the corollary is less popular: if the reasoning holds, it also holds where it produces an answer we do not like.

Dr.MetabolicMD said:

Agreed, and coverage criteria are plan-specific rather than insurer-specific.

Thank you for spelling out the reasoning rather than just the conclusion. Sending this to two other people who asked me the same thing last week.

Dr.GutHealth said:

The version of this that has an answer is narrower than the version being asked.

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.

Ask again with the specifics and you will get a better answer than this one.

Adding the numbers, since they settle part of this. Keep the original post as written when you update it, and add the correction underneath. An edited-away mistake is invisible to the next person who makes it.

Moderator note: reminder that nothing in this thread is medical advice, and that clinical claims need a source.