Answering the narrow version, because the broad one does not have a single answer. Denials are usually procedural rather than clinical, and the order that works reflects that. Get the denial reason in writing, because it names the criterion you failed. Then supply the documentation that criterion asks for — usually documented BMI with a comorbidity, or a failed prior therapy. Then appeal, and ask for a peer-to-peer review, because a prescriber talking to a reviewing clinician resolves a large fraction of denials that written appeals do not. Manufacturer copay assistance is separate and applies mainly to commercial insurance, and patient assistance programmes are means-tested rather than a discount.

mike.trainer_LA said:

Denials are usually procedural rather than clinical, and the order that works reflects that.

Agreed, and coverage criteria are plan-specific rather than insurer-specific. Two people with the same insurer and different employers have different rules, which is why "my insurer covers it" is not transferable information.

RetaRick_CA said:

Living somewhere the domestic route does not exist, which makes most of the advice on this board inapplicable to me.

Can confirm. Same sequence, different timescale.

From the other side of the consultation, briefly.

My experience ordering cross-border ordering internationally: I've ordered from a Canadian pharmacy. Customs can be hit or miss.

Shipping time: 10-21 days
Customs clearance: held for 3 days then released
Quality: Janoshik tested at 99.5% purity

International ordering adds complexity but can save 60-80% compared to US prices. Research your country's import laws first.