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ForumsInternationalGerman private insurance (PKV) vs statutory (GKV) — my results so far

German private insurance (PKV) vs statutory (GKV) — my results so far

JenPlateau Thu, Apr 18, 2024 at 5:12 PM 14 replies 2,230 viewsPage 1 of 3
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JenPlateau
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Missouri
Apr 18, 2024 at 5:12 PM#1

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 the outside.

What I am trying to establish is what actually works on a prior-authorisation denial, as opposed to the list of things that sound like they should work.

Tell me what I have not thought of.

29 7HPLC_Greg, LibrarianMeg, bri_stats and 26 others
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pete_manc_UK
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Mar 2024
Manchester, UK
Apr 18, 2024 at 5:18 PM#2
JenPlateau 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…

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 ($138/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.

30 8RunnerRach, TrialNerd_Beth, HPLC_Greg and 27 others
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oliver_london
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Aug 2024
London, UK
Apr 18, 2024 at 5:24 PM#3
pete_manc_UK said:
Insurance coverage hack for cost and coverage: if your insurance denies brand Wegovy/Ozempic, consider these alternatives: Prior authorization appeal…

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$65$85$0
Monthly Follow-up$35Included$50
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.

Last edited: Apr 18, 2024 at 6:24 PM
31 9Dr.LeslieOBGYN, MikeNYC_runner and 28 others
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SleepFixSam
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Nov 2024
Hawaii
Apr 18, 2024 at 5:30 PM#4
JenPlateau 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…

This matches mine closely enough to be worth saying so out loud. Nothing to add that would improve it.

32 10denise_HTX, raj_cambridge, ingrid_STO and 29 others
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Dr.NephBHM_UK
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Jun 2024
Birmingham, UK
Apr 18, 2024 at 5:59 PM#5

Adding the clinical framing, because it changes how the question reads.

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

  • Groceries: SAVED $235/month (eating less)
  • Restaurants: SAVED $205/month (fewer meals out)
  • Alcohol: SAVED $155/month (stopped drinking)
  • Life insurance: Premium REDUCED by $45/month (lower BMI)
  • Copays: SAVED $55/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.

Last edited: Apr 18, 2024 at 11:59 PM
33 11PeptideChemSF, A1cHero_PHX, Dr.RenalNash and 30 others
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