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Telehealth provider directory — need advice

sophie_paris Thu, May 30, 2024 at 7:00 PM 63 replies 3,076 viewsPage 3 of 13
Dr.KarenChen
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Jun 6, 2024 at 1:21 AM#11
pete_nash said:
Insurance coverage hack for cost and coverage: if your insurance denies brand Wegovy/Ozempic, consider these alternatives: Prior authorization appeal…

My insurance denied my PA related to cost and coverage. Has anyone successfully appealed? I'm considering going compounded instead.

4 2julia.endo, JessicaM_2024, TomFromTexas and 1 other
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AussieAnna
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Jun 2024
Sydney, AU
Jun 6, 2024 at 4:46 AM#12
matt_MKE said:
SarahChen_PharmD said: ...regarding the discontinuation data for cost and coverage...

That reframing is the part I needed. Adding it to my notes with a link back to this thread.

Last edited: Jun 6, 2024 at 5:46 AM
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RetaRick_CA
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Jun 6, 2024 at 8:11 AM#13
pete_nash said:
Insurance coverage hack for cost and coverage: if your insurance denies brand Wegovy/Ozempic, consider these alternatives: Prior authorization appeal…

Financial impact of cost and coverage weight loss beyond medication cost:

  • Groceries: SAVED $277/month (eating less)
  • Restaurants: SAVED $227/month (fewer meals out)
  • Alcohol: SAVED $177/month (stopped drinking)
  • Life insurance: Premium REDUCED by $47/month (lower BMI)
  • Copays: SAVED $57/month (fewer BP/cholesterol meds)

Net impact after medication cost: approximately BREAKING EVEN. The medication pays for itself through reduced food spending and healthcare costs. This surprised me.

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VendorMark
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Jan 2024
Texas
Online
Jun 6, 2024 at 11:36 AM#14
sophie_paris said:
The list price and the price I actually pay differ by a factor of six depending on which of four routes I use, and none of that is transparent from…
sophie_paris said:
...compounded vs brand cost and coverage...

This debate comes up weekly and I think both sides have valid points:

Pro-brand: FDA-approved, manufacturing standards guaranteed, clinical trial data directly applicable

Pro-compounded: 10x cost savings, same active molecule, independent testing available, accessibility

My position: if you can afford brand or have insurance coverage, that's the gold standard. If not, properly tested compounded from a 503B pharmacy is a reasonable alternative. Neither side should shame the other.

Last edited: Jun 6, 2024 at 1:36 PM
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mike_mod
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Jun 6, 2024 at 3:01 PM#15

Moderator note: a post naming a supplier has been edited. Discuss suppliers in the review sections, not here. Tagging this one for the weekly digest.

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