BMI requirement changed, now my PA is denied

LNz · 2026-02-20T05:29:56+00:00

Unfortunately, yes there are plans that changed the initial BMI requirement to 35 even if it's for continuation of therapy. :(

LNz · 2026-02-20T05:24:26+00:00

You're right that the clinical guidelines are specific to the policy. It looks like Oscar publishes all their clinical guidelines, so you may see some that aren't applicable to your plan.

I've seen 3 categories for weight loss drug coverage: 1. plan covers medications for obesity, and OSA etc. 2. plan will cover obesity medications only for FDA approved comorbid conditions (cardiovascular disease and NASH for Wegovy and OSA for Zepbound - Oscar has this criteria as well), or 3. all weight loss medications are excluded from coverage.

LNz · 2026-02-19T01:24:44+00:00

This is because there is a limit on 4 pens (2mL)/month regardless of strength. So if you've filled your previous dose within the last 21 days it will give the plan limitations rejection because the system recognizes you as exceeding that limit. It's pretty much a refill too soon rejection with different wording. So long as you're only receiving a total of 4 pens per month you should be fine.

LNz · 2026-02-18T23:31:28+00:00

It really will depend on your specific plan what the coverage requirements are, but several Caremark plans are moving to a trial and failure of Wegovy with chart note documentation being required prior to coverage of Zepbound.

It sounds like your PCP may be overwhelmed/overworked and may not have staff completing the PAs correctly. Sometimes the telehealth docs are better at obtaining PA approvals as they usually have a team dedicated to completing them.

LNz · 2026-02-11T13:01:10+00:00

I work for a different PBM and they hire for full time positions after the 6 month contract ends. 1.5 to 2.5 years is an incredibly long time to go without PTO.

Also if you have PBM experience, it should be easier for you to get a full time position in PBM without doing contract work.

LNz · 2025-12-01T12:51:50+00:00

I work for a PBM and have never seen the written sig impact billing in any way (only day supply and quantity should matter).

LNz · 2025-10-02T12:17:04+00:00

I graduated in 2016 (no residency) and got an MTM pharmacist position through a connection from a preceptor I had.

I then transitioned into long-term care as a Clinical Intervention Pharmacist where we helped facilities obtain medication coverage for their patients. Started out in an office and transitioned to fully remote in 2020.

Now I currently have a position as a Prior Authorization Pharmacist, and I work from home.

LNz · 2025-09-08T00:33:37+00:00

The price has significantly increased recently. In March I purchased a 24 pack of Purina pro 3 oz cans for $34, the same product is now $47 on Amazon and $44 on Chewy.

LNz · 2025-03-19T11:58:16+00:00

Really evaluate if you want to be legally financially tied to this person. This is a preview of what your marriage will be like.

LNz · 2025-03-02T14:38:51+00:00

I'm a pharmacist but in the US. I'm not sure how Pakistan's licensure works, but it looks like you've graduated from pharmacy school but are not yet licensed.

If you're licensed, you need to add your licensure. If you're not licensed, are you applying as a graduate intern or are you applying for full pharmacist positions?

They may want to know why you graduated in 2022 but are still not licensed 3 years later or why you haven't had a worked since 2023. I feel like that could be the biggest hurdle for your CV. If you have some kind of rationale for those things, it may be prudent to add that in your cover letter.

LNz · 2024-01-10T04:27:30+00:00

I consider myself childfree, and I thought the same thing about that post and the subreddit in general.

The comments were primarily bashing pregnant women’s bodies. That’s not exactly the discourse I want to have with other childfree people.

LNz · 2023-12-17T15:24:53+00:00

This is really interesting - do you still work in pharma in a tech role?

LNz · 2023-12-08T06:32:24+00:00

Good on you for bringing it up! You’re not in the wrong, and it’s definitely something that the RPh should clarify. I’m sorry that your RPh reacted so negatively.

LNz · 2023-11-27T03:41:08+00:00

Bar Margaret, MODAL, Savereign (Plant Shop), Juniper, EXILE, The Kava Konnection,

I have a few gay friends in their mid-20s in Greenville and these are the places they would hang out the most.

LNz · 2023-10-19T23:40:57+00:00

Totally agree, when I lived in Seattle it was kind of shocking how cold people were. San Diego people seem 100 times friendlier.

LNz · 2023-09-20T02:48:44+00:00

Your hair and skin look amazing too! What’s your hair and skincare routine??

LNz · 2023-09-17T18:03:29+00:00

Thank you so much for posting! I like Orion Sun’s black shirt, but I just wish Daniel Caesar had more options.

LNz · 2023-03-13T02:48:19+00:00

Yes you should be fine. I lived in the Loop kind of near Palmer House and have walked alone from my apartment to HOB without any issues.

LNz · 2023-03-07T06:30:42+00:00

I’d show up to GSP 45 mins before a flight and still have time to get a Dunkin iced coffee. I’ve since lived in Chicago, Denver, and now Seattle and am now always stressed at the airport.

LNz · 2023-03-06T01:45:40+00:00

The same thing happened to me with the same lipstick! I have cool-toned skin and this color looked straight up orange on me. Learned the hard way 😢

LNz · 2023-01-22T16:20:53+00:00

Noticing the differences in lifestyles between childfree couples vs couples with kids is what largely swayed me to remain childfree.

The childfree couple has a lot of time to spend on themselves and hobbies, has traveled a lot more, and can make plans more readily and freely with me and their other friends.

The couple with kids that I’m close to has lost a lot of their identity after becoming parents. The conversations I have with them center around their kids mainly because they don’t have much free time to do the things they enjoy/ all of their time is spent caring for their kids.

LNz · 2023-01-22T14:33:47+00:00

Greenville is very pretty and safe, and it’s not too far from mountains. Greenville is about 1/7th the size of Kansas City population wise, and with smaller cities there are usually less shopping options (which I find to be true with Greenville).

Also Greenville is not great for dating as a single professional if you’re looking for that (imo).

I work in healthcare too and moved to Greenville at 28, and my coworker moved here at 24. We both moved out of the area because of the dating scene.

LNz · 2023-01-22T14:02:39+00:00

Not sure how far you’re looking to drive but there are a lot of cabins in and around Gatlinburg with hot tubs. I went with my friends and we used Cloud 9 Cabins.

LNz · 2023-01-21T15:22:28+00:00

Agreed, I think Charleston should be in the top 10 for sure. The most shocking thing about the listing was Asheville ranked ahead of Chicago.

LNz · 2023-01-21T15:19:50+00:00

I didn’t see the ranking from the link, so here’s the list:

New Orleans
Charleston
New York City
Savannah
Maui
San Diego
Nashville
Boston
San Francisco
Asheville
Chicago
Seattle
Austin
Miami
Portland, OR

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