Dr.BariatricHTX said:

The useful move here is to separate what is established from what is widely repeated.

That is right, and it stops being right at the edges. The general case is well behaved; the interesting cases in this thread are all at the boundary where the general case breaks.

NurseKim_ATL said:

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

Genuinely useful, thank you. I had the facts and not the framework. I will report back once I have actually tried it.

Dr.BariatricHTX said:

The useful move here is to separate what is established from what is widely repeated.

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.

One concrete data point for the thread. Give anything pharmacological four weeks before you judge it, and give anything measured weekly a four-point rolling average before you call it a trend.

Worth separating that from cost and coverage, which this thread keeps folding into the same question. They behave differently and the advice does not transfer.

Moderator note: good thread. Keeping it here rather than moving it, because the question is general enough to be useful.