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When compounded semaglutide makes sense: UHC denied coverage and appeals failed or are pending Out-of-pocket cost with insurance exceeds $300/month Patient is on a high-deductible plan and hasn't met the deductible Patient has traditional Medicare Part D (no Wegovy coverage possible) When brand Wegovy makes sense: Insurance covers it with a copay under $100/month Patient prefers the convenience of a pre-filled pen Patient wants FDA-approved medication The clinical outcomes data for compounded semaglutide is limited compared to the published STEP trials for Wegovy, but the pharmacokinetics of semaglutide base are well-established