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ForumsInsurance & AccessMy insurance FINALLY approved it - here is exactly what I did — 12 month update Page 3

My insurance FINALLY approved it - here is exactly what I did — 12 month update

jason_paloalto Mon, Jul 22, 2024 at 11:00 PM 43 replies 2,911 viewsPage 3 of 9
COA_Karl
Senior Member
2,123
8,901
Jan 2024
Pennsylvania
Jul 25, 2024 at 8:57 PM#11
PedsEndoPhilly said:
Financial impact of cost and coverage weight loss beyond medication cost: Groceries: SAVED $205/month (eating less) Restaurants: SAVED $155/month…

Insurance update relevant to cost and coverage: I just got my prior auth approved through Aetna after 1 attempts.

What finally worked: a letter from my endocrinologist documenting BMI history (>3 years), failed diet attempts, comorbidities (PCOS + insulin resistance), and referencing the SELECT 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.

16 14matt_MKE, Dr.ReproEndo, lucas_SP_BR and 13 others
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zoe_NC
Member
278
1,234
Nov 2024
Charlotte, NC
Jul 27, 2024 at 4:25 AM#12
MounjBrad said:
Dr.ObesityMed said: ...regarding the discontinuation data for cost and coverage...

This is exactly what I could not find anywhere else.

17 15FranDenver, Dr.BariatricHTX, LindaRN_retired and 14 others
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RickReta_CO
Member
312
1,234
Jan 2025
Colorado
Jul 28, 2024 at 11:52 AM#13
PedsEndoPhilly said:
Financial impact of cost and coverage weight loss beyond medication cost: Groceries: SAVED $205/month (eating less) Restaurants: SAVED $155/month…

Telehealth prescriber review for cost and coverage: I've used 4 different telehealth platforms to get my GLP-1 prescription. Comparison:

FeaturePlatform APlatform BPlatform C
Initial Consult$65$85$0
Monthly Follow-up$35Included$50
Prescription SpeedSame day24-48 hoursSame day
Lab MonitoringRequiredOptionalRequired

I settled on the one that required labs — it shows they care about safety, not just prescribing volume.

18 16hyun_seoul, jim_asheville, matt_MKE and 15 others
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Dr.PathRoch
Member
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2,123
Jun 2024
Rochester, MN
Jul 29, 2024 at 7:19 PM#14
jason_paloalto 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 ($129/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.

19 17SaraMom3, Dr.MetabolicMD, RetaRick_CA and 16 others
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Admin
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Online
Jul 31, 2024 at 2:45 AM#15

Moderator note: reminder that nothing in this thread is medical advice, and that clinical claims need a source. No action needed from anybody.

20 18PeptideSynthNJ, Dr.KarenChen, Dr.NateNeph and 17 others
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