Hang in there. For me, 3 months of either Zepbound or Wegovy ran just $28 through insurance. When it came to fighting the change, my doctor offered nothing. I agreed to switch to Wegovy and gave it a month. During that time, the daily body composition data from my Withings scale told the story plainly: weight dropping steadily on Zep, then completely flat on Wegovy.
I gathered everything—including my earlier apnea and afib diagnoses—and handed it to an online appeals service. The charge was tiny (less than the cost of 2 pounds of Starbucks), and in return it produced a huge appeal that went out to my insurance and the drug plan administrators.
Rejection came quickly.
So I went back, submitted that rejection, and filed the free 2nd appeal. The volume of paperwork it generated was absurd. The service dispatched it everywhere: the insurer, the plan administrator, my employer’s HR plan administrator, and even state and federal bodies dealing with insurance, health, and the attorney general.
A week hadn’t passed before my insurance notified me that arbitration was mandatory.
The following day, a hefty document arrived from the arbitration firm: the insurance company had acted incorrectly, and its decision had to be overturned.
Two weeks after that, the insurance company told me my authorization would be extended for another year.
And the very next day, I had 3 months of Zepbound in hand.
So do the math. If insurance comes out cheaper, a structured appeal service might be worth trying.
