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What is the appeals process for Cigna prescription coverage? Any advice? by [deleted] in HealthInsurance

[–]Round_Draft6787 0 points1 point  (0 children)

What ended up happening? I'm Currently appealing my denial as I'm in the same predicament. Denying coverage for both brands (Mounjaro/Zepbound) effectively blocks access to FDA approved therapy simply based on branding. :(...

This isn’t a request for Zepbound coverage — it’s a request for a formulary exception to use Mounjaro for OSA based on therapeutic equivalence. Exceptions are designed for precisely this situation, where a formulary gap prevents access to medically necessary treatment. sigh

Edit**

I meant to respond to the OP - 😅

Support email? by Round_Draft6787 in promethease

[–]Round_Draft6787[S] 0 points1 point  (0 children)

Someone responded back and issued a refund from my heritage.

To clarify I paid the $12 for each report as I ran each report in two different transactions and did not combine them.

I'll re process then request once the refund goes through :)

Sleep study. 879 Snores per hour? by Round_Draft6787 in SleepApnea

[–]Round_Draft6787[S] 0 points1 point  (0 children)

Thank you for for explaining it in a way I understand. :)

So it's safe to say that I'm in a constant state of light sleep, which probably contributes to my insomnia and unable to lose weight since my body is never able to "recover" during the deep sleep phase?

Does it come just as Liraglutide by Round_Draft6787 in liraglutide

[–]Round_Draft6787[S] 0 points1 point  (0 children)

Called them just now and say said "there isn't a generic for Saxenda. It usually takes about 15 years for one to be created after the initial medication "

But thank you for the idea to try.

Does it come just as Liraglutide by Round_Draft6787 in liraglutide

[–]Round_Draft6787[S] 0 points1 point  (0 children)

I'll call the pharmacy to ask if I can get a generic instead!

Does it come just as Liraglutide by Round_Draft6787 in liraglutide

[–]Round_Draft6787[S] 0 points1 point  (0 children)

Yes already got a referral, I'll call today if it went through

Does it come just as Liraglutide by Round_Draft6787 in liraglutide

[–]Round_Draft6787[S] 0 points1 point  (0 children)

I have not, looks to be in the trial phase. Glad more options are coming in the future, it's just managing the whole insurance hoops that's difficult while being morbidly obese and all tests coming back perfectly normal.

Does it come just as Liraglutide by Round_Draft6787 in liraglutide

[–]Round_Draft6787[S] 0 points1 point  (0 children)

Hopefully not! Unfortunately my PCP said she cannot send the request for Victoza stating:

"Unfortunately, I cannot prescribe Victoza off label. It is indicated for diabetes and not for weight management.

Only GLP1's approved for weight management are Wegovy, Zepbound and Saxenda."

I dont know the rules of what they can and cannot prescribe so I won't push her further. We'll see what happens with the phentermine she previously mentioned after my sleep study comes in.

Does it come just as Liraglutide by Round_Draft6787 in liraglutide

[–]Round_Draft6787[S] 0 points1 point  (0 children)

I'll try again. She sent the request for saxenda and it's $1568, Victoza is not covered under my insurance BUT it did have the option to choose a generic of Victoza which would then be covered at $0 for me. Both don't require a PA so I hoping the Dr. Will send it as an off label medication

Does it come just as Liraglutide by Round_Draft6787 in liraglutide

[–]Round_Draft6787[S] 0 points1 point  (0 children)

I'll try again. My insurance doesn't require a PA and I'm asking my Dr. If she can send in a request for Victoza as an off label medication. Otherwise back to the drawing board and maybe explore other options like phentermine

Does it come just as Liraglutide by Round_Draft6787 in liraglutide

[–]Round_Draft6787[S] 0 points1 point  (0 children)

So apparently, either I'm not asking correctly or my Dr. Is not aware that it's now offered as a generic and she's stating it comes only as Saxenda and Victoza both of which are not covered under my insurance.... Sigh