I had the same issue with Zepbound (tirzepatide) 10mg/0.5ml when they wanted to push me to Wegovy (semaglutide), even though Zepbound was already working and helping. Zepbound isn't even on their formulary now.
I wrote the insurance company a detailed letter (helped by AI) containing evidence for the benefits of Zepbound over Wegovy and Zepbound over nothing, as well as documented the benefits I already experienced taking the medication. They approved coverage based on this pushback, and I just paid $25 for 3 months' supply.
I get mine on the black market, 50c/mg for semaglutide, $3 per month at my current rate of usage. I’ve been on it for years, I was getting gray market at $12/mg for 3 years before RFK clamped down on that market. It’s exactly the same stuff (for me, no guarantee for others), had it tested in a lab and as the side effect profile is on point. It massively relieved my ME/CFS, back when I started there was no way I could have gotten a prescription let alone insurance to cover it.
GRAY market is way undercounted in peptide use. Go to the gym and there's like 25% of the people there taking gray market peptides (some for weight, some for injury repair, etc)
That would be black market, almost assuredly if you are talking about "injury repair" peptides. Exceedingly few prescribers in the US are writing for those.
Grey market references stuff like HIMS where you are getting a real doctor to write you a prescription and a shady compounding pharmacy takes those Chinese black market peptides, compounds them, and ships them to your door.
Black market is just going direct to the source in China and getting them for yourself without a prescription.
Gray market peptides are excellent. You can do you own independent lab testing, buy with a group who's testing, or buy from a reputable vendor who pre-tests before sales.
Even after all that it comes down to like $50 a month at the highest dose.
I wrote the insurance company a detailed letter (helped by AI) containing evidence for the benefits of Zepbound over Wegovy and Zepbound over nothing, as well as documented the benefits I already experienced taking the medication. They approved coverage based on this pushback, and I just paid $25 for 3 months' supply.
Might be a potential avenue for some folks...