u/ines_krastev

Correction: that is a formulary exclusion, not a prior authorisation denial. Different form, different route, different deadline.

Gently disagree with the framing — nothing has gone wrong. Week 15 looking flat is the ordinary experience.

Yes — nobody here is your clinician, and the good answers on this board all end with that.

What is the actual question underneath the question? Happy to answer both.

Is this your first step up or the starting dose?

Pen or vial?

The injection was scarier in my head than in reality. It took about ten seconds and I felt slightly silly afterwards.

appetite change usually shows up before the scale does

Not convinced.

Agreed — and request the bulletin by number. They have to give it to you.

keep every date, every reference number, every name of a department

Concentration is mass over volume, and a U-100 syringe reads 100 units per millilitre. Those two facts are the whole of the arithmetic this board keeps explaining.

Spent six weeks arguing in general terms and got nowhere. Two paragraphs quoting their own criteria turned it around in eleven days.

ask for the denial reason in writing, always

That comparison is between two different products at two different concentrations, which is where the confusion is coming from.

That criterion is from the previous plan year. The current bulletin has different wording.

the diagnosis code on the claim is doing more work than anything you write

What does the wiki page on this say — genuinely asking, not deflecting?

the denial letter names the criterion, start there

Has the appetite changed, even if the scale has not?

Right, and keeping every date and reference number turns a frustrating process into an auditable one.

keep every date, every reference number, every name of a department

document what has been tried and for how long, that is the whole case

I would not skip the peer-to-peer.

Agreed — and request the bulletin by number. They have to give it to you.

Documented eighteen months of what had been tried in a one-page table. That table was the appeal.

prior authorisation criteria change every plan year

canada_coverage is right that this is documentation rather than persuasion. It took me a year to accept that.

search first, but a repeat question is not a crime

What has been documented as tried, and for how long?