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ForumsInsurance & AccessPaying $300 per month out of pocket - is there a cheaper way?? — anyone have experience?

Paying $300 per month out of pocket - is there a cheaper way?? — anyone have experience?

Dr.MetabolicMD Wed, Jun 4, 2025 at 5:41 AM 29 replies 1,602 viewsPage 1 of 6
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Dr.MetabolicMD
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Jun 4, 2025 at 5:41 AM#1

Denied on prior authorisation twice, approved on the third attempt after a peer-to-peer, and the only thing that changed was who was doing the talking.

The bit I cannot resolve on my own is what actually works on a prior-authorisation denial, as opposed to the list of things that sound like they should work.

Practical detail welcome, however dull — the duller the better.

31 1SleepDoc_PDX, RegAffairsDC, BiostatsBrad and 28 others
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KevinCompounds
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Jun 4, 2025 at 6:35 AM#2
Dr.MetabolicMD said:
Denied on prior authorisation twice, approved on the third attempt after a peer-to-peer, and the only thing that changed was who was doing the…

Telehealth prescriber review for cost and coverage: I've used 4 different telehealth platforms to get my GLP-1 prescription. Comparison:

FeaturePlatform APlatform BPlatform C
Initial Consult$56$86$0
Monthly Follow-up$36Included$56
Prescription SpeedSame day24-48 hoursSame day
Lab MonitoringRequiredOptionalRequired

I settled on the one that required labs — it shows they care about safety, not just prescribing volume.

30 0Dr.RaviCardio, jennifer_SEA, tyler_CSCS and 27 others
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Dr.GastroMayo
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Jun 4, 2025 at 7:29 AM#3
KevinCompounds said:
Telehealth prescriber review for cost and coverage: I've used 4 different telehealth platforms to get my GLP-1 prescription.

Insurance coverage hack for cost and coverage: if your insurance denies brand Wegovy/Ozempic, consider these alternatives:

  1. Prior authorization appeal with peer-to-peer review
  2. Manufacturer copay card (for commercial insurance)
  3. Patient assistance programs (Novo Nordisk, Eli Lilly)
  4. Compounded medication from a 503B pharmacy ($106/month)
  5. Canadian pharmacy (requires prescription, ~40-60% savings)

Don't let cost prevent access to effective treatment. There are options at every price point.

Last edited: Jun 4, 2025 at 12:29 PM
29 24COA_Karl, MikeFit_NJ, InsuranceTom and 26 others
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SallyK_inj
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Iowa
Jun 4, 2025 at 8:23 AM#4
Dr.MetabolicMD said:
Denied on prior authorisation twice, approved on the third attempt after a peer-to-peer, and the only thing that changed was who was doing the…

Can confirm. Same sequence, different timescale.

Last edited: Jun 4, 2025 at 9:23 AM
28 23tane_welly, Dr.PathRoch, mona_PHX and 25 others
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MASHdoc_SA
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Jun 4, 2025 at 1:31 PM#5

From the other side of the consultation, briefly.

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

Last edited: Jun 4, 2025 at 4:31 PM
27 22kate.chem, DataDave, Dr.GutHealth and 24 others
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