Shield Health Solutions

Short answer: most specialty pharmacies and larger, integrated telehealth providers will help manage prior authorization (PA) requests — but exact handling varies by insurer, state and the specific telehealth service. Below are specific names and why they’re helpful plus what you should do next. Providers/services that commonly handle PA for Ozempic (semaglutide) Novo Nordisk / NovoCare (manufacturer support hub) Why: NovoCare provides benefits verification, PA paperwork assistance and appeals support for Novo Nordisk products (including Ozempic). Good first stop for coverage questions and enrollment in copay assistance programs. Specialty pharmacies (they routinely manage PA) Examples: CVS Specialty, Walgreens Specialty Pharmacy, Optum/Accredo, Diplomat/Shield Health Solutions Why: Specialty pharmacies are set up to submit and follow up on PA/appeals for injectable and specialty meds; they coordinate directly with prescribers and insurers. Large telehealth/virtual-care companies that coordinate with insurers Examples: Teladoc Health (including Livongo programs), One Medical, Amwell, Carbon Health Why: These integrated services commonly work with patients’ insurers and local pharmacies and will often submit supporting documentation or initiate a PA when appropriate. Diabetes-focused virtual clinics / care teams Examples: Onduo (Alphabet/Verily partner programs), local health-system diabetes programs Why: Programs that manage chronic diabetes care usually have workflows to obtain PA for GLP‑1s and other diabetes meds. Other telehealth clinics that prescribe GLP‑1s (varies by company) Examples you might encounter: Ro, Hims & Hers, PlushCare Caveat: Some direct-to-consumer GLP‑1/weight-loss programs operate cash-pay or limit insurance billing; if you want PA handled, confirm beforehand. What to do next (practical steps) Call your insurer to confirm whether Ozempic (semaglutide) is covered, whether PA is required, and what documentation is needed. Ask which specialty pharmacy they prefer. Ask any telehealth/clinic you’re considering: “Do you submit prior authorizations and appeals to my insurance, or will I need to do that?” Get a clear answer. If prescribed, request that the prescriber send the script to the insurer’s preferred specialty pharmacy and enroll in NovoCare for manufacturer assistance. If a PA is denied, ask the provider or specialty pharmacy to file an appeal (many will help). If you tell me your insurer (e.g., UnitedHealthcare, CVS Caremark/ Aetna, Express Scripts, etc.) and which online provider you’re considering, I can give more specific guidance on likely PA workflows and who to contact.

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