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c/insurancefights·posted 5 months ago by u/idris_iyer

[PSA] formulary is not what most of this community thinks it is

Win Receipts ×5 Well Actually ×3

Something I noticed reading old threads that I have not seen said out loud.

The advice on copay in this community changed substantially around the start of last year, and nobody went back and updated the older posts. So depending on which thread the search engine hands you, you get two contradictory answers with the same confidence.

I have listed what I think the current consensus is below. Correct me — that is the point of posting it.

1,420 up / 299 down83% upvoted63 commentsid 1esq033 Feb 2026

63 comments

23 in this archive, depth 6

best — the order this archive was captured in

u/step_therapy_sMOD71 points·5 months ago

Tracking number removed. It identifies both ends of a shipment.

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u/kian_balogun84 points·5 months ago

redact member ids and group numbers from every screenshot

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u/maren_ibarra44 points·5 months ago

The practical rule people converge on is 28 days at fridge temperature after first puncture, and that comes from the preservative, not the peptide.

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u/elise_grimaldi36 points·5 months ago

I am going to push back on this slightly.

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u/milos_vestergaard24 points·5 months ago·edited

do not suggest misrepresenting a diagnosis, that is fraud

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u/idris_iyerOP13 points·5 months ago

external review is the appeal after insurance says no

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u/plain_titration_202425 points·5 months ago

Half-life is about 168 hours, so steady state lands around week 11–5. Practical consequence: what you feel in week 1 is not what that dose does.

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u/ferritin_low9 points·5 months ago

Half-life is about 168 hours, so steady state lands around week 11–5.

Adding to this: formulary is doing more work than the comment implies.

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u/hassan_chowdhury16 points·5 months ago

External review overturned the denial. Took 3 weeks but the process exists.

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[removed]6 points·5 months ago

[removed by moderator]

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u/RetaAndRegret27 points·5 months ago

step therapy documentation is the weapon, use it

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u/purity_pedantanalytical4 points·5 months ago

do not suggest misrepresenting a diagnosis, that is fraud

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u/hassan_chowdhury-4 points·5 months ago

appeal letter templates are in the wiki

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u/saskia_lokken1 point·5 months ago

I am going to push back on this slightly.

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u/vito_beaulieu2 points·5 months ago·edited

[removed by moderator]

Yes, exactly this, and it is the bit that took me 76 weeks to accept.

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u/muscle_cramp_mo11 points·5 months ago

redact member ids and group numbers from every screenshot

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u/arne_amankwah5 points·5 months ago

Sceptical. If this were true we would see it reflected in the data and we do not.

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u/muscle_cramp_mo3 points·5 months ago

formulary exclusions are negotiable sometimes

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u/whois_wanda2 points·5 months ago

This is correct. Appeal letters work.

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u/kian_balogun5 points·5 months ago

That is net peptide content, not purity. Different number, different meaning.

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u/ahmed_abubakar6 points·5 months ago

step therapy documentation is the weapon, use it

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u/idris_iyer7 points·5 months ago

the carve-out clause varies by employer

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u/ines_krastev5 points·5 months ago

say which country and which plan type

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About c/insurancefights

The paperwork war. Prior-authorisation criteria, denial reason codes, step-therapy documentation, external review, employer carve-outs, and the appeal letter templates the community has iterated on for three years. Mostly US-shaped but the tactics generalise.

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c/insurancefights rules
  1. Say which country and which plan type. "Insurance" means eleven different things.
  2. Redact member ids and group numbers from every screenshot.
  3. Do not suggest misrepresenting a diagnosis. That is fraud and it gets you banned.
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