How is this not covered but my coworker gets Viagra no questions asked — 12 month update

TirzTom said:

SkepticalSean said: ...regarding the discontinuation data for cost and coverage...

Pushing back on TirzTom here. 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.

SkepticalSean 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…

SkepticalSean 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.

Dr.ObesityLA said:

The affordability discussion here usually stops at individual tactics.

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

One thing that is still open after matt_MKE’s answer:

How would you tell the difference between that and the alternative explanation?

Reporting back.

Follow-up — getting the denial reason in writing was the step that mattered. It named the criterion, and the criterion was a document I already had.