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ForumsInsurance & Access2026 payer coverage update — GLP-1 formulary changes by insurer Page 7

2026 payer coverage update — GLP-1 formulary changes by insurer

InsuranceTom Mon, Feb 26, 2024 at 4:00 PM 377 replies 33,823 viewsPage 7 of 20
newstart_MO
New Member
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Feb 2026
Springfield, MO
Mar 21, 2024 at 8:40 AM#31
InsuranceTom said:
Update: approved on the third attempt after a peer-to-peer.

I read this differently from InsuranceTom, on substance rather than tone. This treats a plausible mechanism as a demonstrated one. Plausible is where you start looking, not where you stop.

Last edited: Mar 21, 2024 at 2:40 PM
3 1bri_stats, pete_manc_UK, anna.melb_AU
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zoe_NC
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1,234
Nov 2024
Charlotte, NC
Mar 23, 2024 at 2:55 AM#32
InsuranceTom said:
Update: approved on the third attempt after a peer-to-peer.

Agreed, and one caution: a single measurement is not a measurement. Anything that moves day to day needs a trend before it means anything at all.

Last edited: Mar 23, 2024 at 3:55 AM
4 2FranDenver, Dr.BariatricHTX, LindaRN_retired and 1 other
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kevin_tulsa
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Jun 2024
Tulsa, OK
Mar 24, 2024 at 9:09 PM#33
InsuranceTom said:
Update: approved on the third attempt after a peer-to-peer.

This answered a question I did not know how to ask. Taking it to my next appointment.

5 3greg_boulder, quinn_sf, NurseLeah_Nash and 2 others
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claudia_zurich
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Jul 2024
Zurich, CH
Mar 26, 2024 at 3:22 PM#34

Adding the clinical framing, because it changes how the question reads. It is worth asking what the claim would look like if it were false. If nothing would look different, it is not a claim about the world and no amount of discussion will settle it.

Correct me if the detail matters more than I have assumed.

6 4alex_tucson, kevin_tulsa, Dr.PainCLE and 3 others
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KristenIndy
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May 2024
Indianapolis, IN
Mar 28, 2024 at 9:34 AM#35
claudia_zurich said:
It is worth asking what the claim would look like if it were false.

Same experience, arrived at from the opposite direction. The detail I would add is minor and it is already implied above.

7 5kate.chem, DataDave, Dr.GutHealth and 4 others
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