Don’t give up. My insurance was only $28 for 3 months of Zepbound or Wegovy. My doctor was zero help on pushing back. I let them shift me to Wegovy and waited a month. By that time my daily body composition log from Withings scale showed a clear picture. A nice steady fall in weight on Zep and a total stall on Wegovy.
I took all of that info, including prior apnea and afib diagnosis, over to one of the online appeals service. For a very small fee ( < 2 pounds of Starbucks) it generated a massive appeal and sent it to my insurance and drug plan administrators.
I got a prompt rejection.
I went back, uploaded the rejection, and used the free 2nd appeal. The stack of documents it churned out was insane. That was sent by the service to the entire universe…. Insurance, plan admin, work HR plan admin, and even state and federal agencies concerned with insurance, health and attorney general.
Within a week I received a notice from my insurance that they were required to go to arbitration.
The next day I received a massive document from the arbitration firm stating that the insurance company was wrong and their decision must be reversed.
Two weeks later I received notice from the insurance company that they would be extending my authorization for another year.
I had 3 months of Zepbound the very next day.
Soooooo run the math. If insurance is cheaper, you may want to try a structured appeal service.
