Eli Lilly patient assistance programs — my results so far

Dr.ObesityLA said:

sarah.morrison said: ...regarding the discontinuation data for cost and coverage...

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 ($148/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.

SleepFixSam said:

Financial impact of cost and coverage weight loss beyond medication cost: Groceries: SAVED $229/month (eating less) Restaurants: SAVED $199/month…

Genuinely useful, thank you. I had the facts and not the framework. Sending this to two other people who asked me the same thing last week.

Dr.ObesityLA said:

sarah.morrison said: ...regarding the discontinuation data for cost and coverage...

Dr.ObesityLA said:

...my insurance denied cost and coverage coverage because...

Insurance denial is the single biggest barrier to GLP-1 access. Let me share the appeal framework that worked for me and several community members:

1. Document medical necessity (BMI, comorbidities, failed alternatives)
2. Reference clinical practice guidelines (AGA, AACE, Endocrine Society)
3. Cite cost-effectiveness data (preventing diabetes/surgery saves money long-term)
4. Request peer-to-peer review between your doctor and the plan's medical director
5. File external appeal with your state insurance department if internal appeal fails

Don't accept the first denial. The appeal process exists for a reason.

Dr.DermMIA 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…

Insurance update relevant to cost and coverage: I just got my prior auth approved through Aetna after 3 attempts.

What finally worked: a letter from my endocrinologist documenting BMI history (>3 years), failed diet attempts, comorbidities (sleep apnea + prediabetes), and referencing the SURMOUNT trial data.

If your PA keeps getting denied, don't give up. Request a peer-to-peer review between your doctor and the insurance medical director. That's what finally broke through for me.

Moderator note: good thread. Keeping it here rather than moving it, because the question is general enough to be useful.