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Path 1: Clear diabetes coverage (A1C 7.0+, metformin trial documented) Optimal strategy: Submit prior authorization through Aetna Expected timeline: 3-5 days to approval Expected cost: $50-$250 per month copay (depending on tier and deductible status) When to pivot: If denied despite meeting criteria, appeal immediately and consider compounded during appeal Path 2: Weight loss with uncertain coverage (plan may or may not include obesity medications) Optimal strategy: Call Aetna member services first to confirm coverage before asking provider to submit PA Expected timeline: 1-2 days to confirm coverage, then 7-14 days for PA if coverage exists Expected cost: Highly variable ($0-$1,200+ depending on deductible and tier) When to pivot: If plan excludes obesity medications, compounded tirzepatide is faster and often cheaper than fighting for coverage that doesn't exist Path 3: Weight loss with confirmed exclusion or Medicare Advantage Optimal strategy: Start with compounded tirzepatide immediately Expected timeline: 5-7 days from consultation to first dose Expected cost: $297-$397 per month When to pivot: If you develop type 2 diabetes (A1C rises to 6.5% or higher), resubmit for diabetes coverage The decision model is simple: if you have type 2 diabetes and documented metformin trial, insurance is worth pursuing

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However, they are a good option for getting more protein with fewer carbs