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ForumsInsurance & AccessPrior auth denied for the 3rd time - what am I doing wrong — my results so far

Prior auth denied for the 3rd time - what am I doing wrong — my results so far

PharmD_Rodriguez Fri, Sep 26, 2025 at 2:12 AM 12 replies 1,178 viewsPage 1 of 3
PharmD_Rodriguez
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Sep 26, 2025 at 3:37 AM#1

Specific question about prior auth denied for the 3rd that I have not seen answered clearly anywhere:

Does timing matter?

Context: I am week 4 on 0.5mg sema. My provider said one thing but I have read conflicting info online.

Would appreciate hearing from people with direct experience, not just theoretical answers.

16 0paul_denver, TinaHashiRN, robert_kc and 13 others
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pete_manc_UK
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Manchester, UK
Sep 26, 2025 at 3:54 AM#2

PharmD_Rodriguez's experience with Prior auth denied for the resonates deeply with mine. I went through almost the identical process — starting dose, titration timeline, side effects, everything.

The main difference: I started 3 months later. But the overall trajectory has been remarkably similar. Down 42 lbs in 7 months.

One thing I would add that PharmD_Rodriguez did not mention: the mental health improvements were just as significant.

37 2RunnerRach, TrialNerd_Beth, HPLC_Greg and 34 others
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TrialTracker_MD
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Maryland
Sep 26, 2025 at 4:11 AM#3

Thanks for sharing this, PharmD_Rodriguez. A few questions about your Prior auth denied experience:

  1. What dose did you start at?
  2. How long before you noticed side effects improving?
  3. Did your provider have any specific recommendations about Prior auth deni?

I am in a similar boat and trying to learn from others' experiences before my next appointment.

20 16maya_sedona, stefan_berlin, Dr.EM_Chicago and 17 others
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PharmD_Rodriguez
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Jan 2024
Miami, FL
Sep 26, 2025 at 4:28 AM#4

OP here — wow, did not expect this much response! Thank you all for the thoughtful replies on Prior auth denied for the.

To answer TrialTracker_MD: I get my labs done through Quest every 3 months.

Quick update: my latest labs came back even better. Thanks again for the evidence-based discussion — this is exactly why I posted in a science-based community. 🙏

33 20dan_philly, MeganSA_TX, LarryQC_SD and 30 others
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LabKate
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Sep 26, 2025 at 4:45 AM#5

Relevant to Prior auth denied for the 3rd — here is my latest bloodwork comparison:

Key improvements: A1C 7.2% → 5.3%, triglycerides 235 → 105 mg/dL, hsCRP 6.0 → 1.1 mg/L. All on tirzepatide for 15 months.

The inflammatory marker drop is what impresses me most. Consistent with the SELECT trial's cardiovascular findings.

10 23labquiet_amy, emily_PDX, Dr.SleepRoch and 7 others
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