Second pass at: Coverage in the US: a map of the usual obstacles

On the subject in the title: Second pass at: Coverage in the US: a map of the usual obstacles Working notes rather than a conclusion.

A coverage question with the paperwork detail included, since that is what determines the answer.

Denial received, with a stated reason. My reading of the reason is that it tells me exactly what to submit next, which is the useful thing about a well-written denial.

Before I spend a week on it: is my reading of the stated criterion correct, and is there a documented precedent for this specific ground?

Coming back to the opening post, 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.

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.

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.

This follows post #2 rather than contradicting it.

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