GLP-1 Prior Authorization Bridge Cost

Waiting on prior authorization or an appeal can force patients to self-fund GLP-1 injections. Provide the retail cash price, how many weeks the plan may take to respond, and any copay-card help or doses already in your fridge. The calculator returns the uncovered window, how many out-of-pocket fills you must buy, and the bridge budget you need to keep therapy on track.

Sticker price for a 4-week GLP-1 fill at retail.
How long the plan may take to approve or appeal the prescription.
Defaults to $0 if manufacturer assistance cannot be applied.
Subtract overlap from the uncovered window.

Drug pricing varies by pharmacy, dose, and insurance rules. Confirm eligibility for copay assistance and consult your prescriber before altering therapy.

Examples

  • $1,079 monthly cash price, 6-week gap, $150 copay card, 2 weeks on hand ⇒ Uncovered weeks requiring cash: 4.00 • Bridge cost: $3,716.00 USD • Weekly outlay: $232.25 USD • Fills to purchase: 1.00 • Monthly equivalent spend: $3,716.00 USD
  • $950 cash price, 10-week gap, no assistance, zero supply ⇒ Uncovered weeks requiring cash: 10.00 • Bridge cost: $9,500.00 USD • Weekly outlay: $237.50 USD • Fills to purchase: 3.00 • Monthly equivalent spend: $3,166.67 USD

FAQ

What if the plan backdates approval?

Some insurers reimburse retroactively once authorization is granted. Run the calculator twice—once for the cash you must float and again for the amount you expect back—to size the net exposure.

Does this assume a specific titration schedule?

No. It assumes a flat monthly cash price. If your dose increases mid-gap, rerun the numbers with the higher retail amount to stay conservative.

Can I model compounded semaglutide?

Yes. Enter the compounded pharmacy’s monthly quote in the cash price field and zero out the copay offset if assistance does not apply to compounded fills.

Additional Information

  • One monthly fill is assumed to cover four weeks of dosing (28 days), so weekly cost equals the net monthly price divided by four.
  • The bridge budget ignores insurer reimbursement; once coverage is granted you can update the inputs with the new copay to model ongoing spend.
  • If manufacturer assistance is not honored during the gap, leave the offset field at $0 to avoid underestimating cash needs.

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