Coverage in the US: a map of the usual obstacles

Picking up post #12: that is the part I would want checked first.

Telehealth prescribing: widespread in the US and varying in quality. Models without a clinician reviewing measurements and history are not recommended by this community.

Coming back to post #14, because the follow-up matters more than the original answer.

Canada: Health Canada licenses compounds. Prescribing is provincial. Compounds are prescription-only. Coverage varies between public and private insurance.

Thank you for the correction. I have edited my earlier post with a note rather than silently, so the thread still makes sense to read. The error was mine and it was the kind that comes from remembering a figure instead of looking it up.

Cross-border purchase: buying in the US and bringing to Canada or vice versa involves both countries' import rules. The medication is legal but crossing borders with it is regulated.

Regional variation in North America: access differs substantially by US state and Canadian province. Postcode is a major determinant of access.

Having read the exchange above, I think I was wrong earlier in this topic and I want to say so plainly rather than quietly editing.

The correction was fair and I had been repeating something I had not checked carefully enough.

I read post #19 twice before replying, because I had assumed the opposite.

United States: FDA licenses compounds. Prescribing and pharmacy practice are state-regulated. Compounds are prescription-only. Coverage is decided by individual plans, not nationally.

Thank you for the correction. I have edited my earlier post with a note rather than silently, so the thread still makes sense to read. The error was mine and it was the kind that comes from remembering a figure instead of looking it up.

Compounding pharmacies: pharmaceutical compounding of a drug not on the FDA shortage list is substantially constrained. The landscape changed when supply normalised. Current compounding availability is limited.

post #23 is right about the mechanism and I think understates the practical bit.

Provincial formularies in Canada are published and are the correct source for coverage information. Coverage for weight management is less common than for diabetes.

Coming back to post #23, because the follow-up matters more than the original answer.

Having read the exchange above, I think I was wrong earlier in this topic and I want to say so plainly rather than quietly editing.

The correction was fair and I had been repeating something I had not checked carefully enough.

Picking up post #23: that is the part I would want checked first.

Private insurance gaps: some people have private insurance but medication is not covered. Manufacturer assistance programmes are the main resource for cost reduction.

Indigenous healthcare systems: different indigenous healthcare systems have different medication access. Pathways through tribal health systems differ from mainstream healthcare.

Regional variation in North America: access differs substantially by US state and Canadian province. Postcode is a major determinant of access.

Compounding pharmacies: pharmaceutical compounding of a drug not on the FDA shortage list is substantially constrained. The landscape changed when supply normalised. Current compounding availability is limited.

Prior authorisation, step therapy, and exclusion of weight-management indications from coverage are common access barriers. The denial letter tells you which barrier you are facing.