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Page 2 of 2 · 35 questions tagged insurance.

35 questions · sorted by votes · page 2 of 2

13 votes4 answers7.3k views
What does a payer want to see before approving survodutide?

The pharmacy is accredited and I have verified that on the accreditor register. I am trying to do this correctly the first time rather than learn it by getting it…

prior-authorization
prior-authorization

Prior authorisation mechanics: medical-necessity criteria, documenting a lifestyle-intervention requirement, step therapy, and the…

19 questions
insurance
insurance

Coverage: formulary tiers, exclusion versus non-coverage, the difference a diabetes indication makes, employer carve-outs, and what an appeal…

35 questions
t2dm
t2dm

Type 2 diabetes: glycaemic endpoints, the SURPASS and SUSTAIN programmes, dose ranges licensed for diabetes versus obesity, and interaction with…

22 questions
survodutide
survodutide

A GLP-1 and glucagon receptor dual agonist with a substantial published MASH dataset. Use this tag for its hepatic endpoints, its dose ladder, and…

225 questions
asked by priya_menon 13k · 6 months ago
12 votes 5 answers22k views
What does a payer want to see before approving mazdutide?

I have the plan documents and the written criteria, which took two calls to obtain. I can find plenty of assertions about this and almost no reasoning, which is…

prior-authorization
prior-authorization

Prior authorisation mechanics: medical-necessity criteria, documenting a lifestyle-intervention requirement, step therapy, and the…

19 questions
insurance
insurance

Coverage: formulary tiers, exclusion versus non-coverage, the difference a diabetes indication makes, employer carve-outs, and what an appeal…

35 questions
t2dm
t2dm

Type 2 diabetes: glycaemic endpoints, the SURPASS and SUSTAIN programmes, dose ranges licensed for diabetes versus obesity, and interaction with…

22 questions
mazdutide
mazdutide

A GLP-1 and glucagon receptor dual agonist developed primarily in China, with a distinct dose range and a fast-moving publication record.…

237 questions
asked by sample_id 17k · 14 months ago
12 votes 5 answers12k views
What does a payer want to see before approving retatrutide?

This is a United States plan; I appreciate the answer is jurisdiction-specific. Everything I have found on this is either a forum aside or a product page, neither of…

prior-authorization
prior-authorization

Prior authorisation mechanics: medical-necessity criteria, documenting a lifestyle-intervention requirement, step therapy, and the…

19 questions
insurance
insurance

Coverage: formulary tiers, exclusion versus non-coverage, the difference a diabetes indication makes, employer carve-outs, and what an appeal…

35 questions
t2dm
t2dm

Type 2 diabetes: glycaemic endpoints, the SURPASS and SUSTAIN programmes, dose ranges licensed for diabetes versus obesity, and interaction with…

22 questions
retatrutide
retatrutide

An investigational GLP-1, GIP and glucagon receptor tri-agonist, studied in the TRIUMPH programme. Not approved anywhere. Use this tag for…

251 questions
asked by anouk_desmet 16k · 10 months ago
12 votes 5 answers7.2k views
Is an external review worth pursuing after two internal denials?

This is a United States plan; I appreciate the answer is jurisdiction-specific. I would like to set this up properly once, rather than adjust it repeatedly. My budget…

insurance
insurance

Coverage: formulary tiers, exclusion versus non-coverage, the difference a diabetes indication makes, employer carve-outs, and what an appeal…

35 questions
prior-authorization
prior-authorization

Prior authorisation mechanics: medical-necessity criteria, documenting a lifestyle-intervention requirement, step therapy, and the…

19 questions
cost-analysis
cost-analysis

Cost arithmetic done honestly: cost per milligram after dead-space loss, list versus net price, comparing a multi-dose vial to a fixed-dose pen,…

260 questions
asked by coring_risk 27k · 3 months ago
11 votes 3 answers12k views
What does a payer want to see before approving tirzepatide?

I have been through one internal appeal already and would like to do the next one properly. I want a method I can write down and repeat, not a rule of thumb. I would…

prior-authorization
prior-authorization

Prior authorisation mechanics: medical-necessity criteria, documenting a lifestyle-intervention requirement, step therapy, and the…

19 questions
insurance
insurance

Coverage: formulary tiers, exclusion versus non-coverage, the difference a diabetes indication makes, employer carve-outs, and what an appeal…

35 questions
t2dm
t2dm

Type 2 diabetes: glycaemic endpoints, the SURPASS and SUSTAIN programmes, dose ranges licensed for diabetes versus obesity, and interaction with…

22 questions
tirzepatide
tirzepatide

A dual GIP and GLP-1 receptor agonist. Questions here cover the SURPASS and SURMOUNT programmes, the practical differences from a pure GLP-1…

370 questions
asked by Dr_Sara_Kuusela 28k · 10 months ago
11 votes3 answers3.6k views
How do I model twelve months of survodutide across supply routes?

I would rather spend on verification than on volume. Please show the division. I want to check my own against yours. I would like the general form as well as the…

cost-analysis
cost-analysis

Cost arithmetic done honestly: cost per milligram after dead-space loss, list versus net price, comparing a multi-dose vial to a fixed-dose pen,…

260 questions
insurance
insurance

Coverage: formulary tiers, exclusion versus non-coverage, the difference a diabetes indication makes, employer carve-outs, and what an appeal…

35 questions
compounding
compounding

Compounded preparations: what a 503A and a 503B facility may legally prepare and when, base versus salt forms, beyond-use dating under USP…

61 questions
survodutide
survodutide

A GLP-1 and glucagon receptor dual agonist with a substantial published MASH dataset. Use this tag for its hepatic endpoints, its dose ladder, and…

225 questions
asked by cold_lane 10k · 7 months ago
10 votes5 answers6.6k views
What does a payer want to see before approving a GLP-1 receptor agonist?

I have the plan documents and the written criteria, which took two calls to obtain. I can find plenty of assertions about this and almost no reasoning, which is…

prior-authorization
prior-authorization

Prior authorisation mechanics: medical-necessity criteria, documenting a lifestyle-intervention requirement, step therapy, and the…

19 questions
insurance
insurance

Coverage: formulary tiers, exclusion versus non-coverage, the difference a diabetes indication makes, employer carve-outs, and what an appeal…

35 questions
t2dm
t2dm

Type 2 diabetes: glycaemic endpoints, the SURPASS and SUSTAIN programmes, dose ranges licensed for diabetes versus obesity, and interaction with…

22 questions
asked by helena_vidmar 8.5k · 4 months ago
8 votes 5 answers26k views
What does a payer want to see before approving semaglutide?

This is a United States plan; I appreciate the answer is jurisdiction-specific. I am trying to do this correctly the first time rather than learn it by getting it…

prior-authorization
prior-authorization

Prior authorisation mechanics: medical-necessity criteria, documenting a lifestyle-intervention requirement, step therapy, and the…

19 questions
insurance
insurance

Coverage: formulary tiers, exclusion versus non-coverage, the difference a diabetes indication makes, employer carve-outs, and what an appeal…

35 questions
t2dm
t2dm

Type 2 diabetes: glycaemic endpoints, the SURPASS and SUSTAIN programmes, dose ranges licensed for diabetes versus obesity, and interaction with…

22 questions
semaglutide
semaglutide

A GLP-1 receptor agonist with a fatty-acid-acylated backbone and a roughly one-week half-life, marketed for type 2 diabetes and for weight…

470 questions
asked by Dr_Elias_Weiss 25k · 22 months ago
6 votes 5 answers6.5k views
How do I model twelve months of a GLP-1 receptor agonist across supply routes?

I have kept every message, invoice and document, which I gather is the useful habit. This should be a straightforward calculation and I keep getting two different…

cost-analysis
cost-analysis

Cost arithmetic done honestly: cost per milligram after dead-space loss, list versus net price, comparing a multi-dose vial to a fixed-dose pen,…

260 questions
insurance
insurance

Coverage: formulary tiers, exclusion versus non-coverage, the difference a diabetes indication makes, employer carve-outs, and what an appeal…

35 questions
compounding
compounding

Compounded preparations: what a 503A and a 503B facility may legally prepare and when, base versus salt forms, beyond-use dating under USP…

61 questions
asked by mira_sundqvist 7.1k · 6 months ago
5 votes5 answers7.6k views
How do I model twelve months of orforglipron across supply routes?

I am comparing three suppliers on documentation rather than on price. I have worked this out and I would like someone to find the error, because I suspect there is…

cost-analysis
cost-analysis

Cost arithmetic done honestly: cost per milligram after dead-space loss, list versus net price, comparing a multi-dose vial to a fixed-dose pen,…

260 questions
insurance
insurance

Coverage: formulary tiers, exclusion versus non-coverage, the difference a diabetes indication makes, employer carve-outs, and what an appeal…

35 questions
compounding
compounding

Compounded preparations: what a 503A and a 503B facility may legally prepare and when, base versus salt forms, beyond-use dating under USP…

61 questions
orforglipron
orforglipron

A non-peptide, orally bioavailable small-molecule GLP-1 receptor agonist studied in the ATTAIN programme. It is not a peptide, which changes…

219 questions
asked by rhian_prydderch 23k · 16 months ago
1 vote3 answers1.5k views
What does a payer actually need to see in a prior-authorisation request?

I would like to understand the process rather than be told to try harder. I am trying to do this correctly the first time rather than learn it by getting it wrong. I…

prior-authorization
prior-authorization

Prior authorisation mechanics: medical-necessity criteria, documenting a lifestyle-intervention requirement, step therapy, and the…

19 questions
insurance
insurance

Coverage: formulary tiers, exclusion versus non-coverage, the difference a diabetes indication makes, employer carve-outs, and what an appeal…

35 questions
t2dm
t2dm

Type 2 diabetes: glycaemic endpoints, the SURPASS and SUSTAIN programmes, dose ranges licensed for diabetes versus obesity, and interaction with…

22 questions
asked by Dr_Ravi_Selvarajah 35k · 2 months ago