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The most common denial sequence: Patient requests Ozempic from primary care provider for weight loss Provider submits prior authorization with diagnosis code E66.9 (obesity) Ambetter auto-denies within 24 hours (no human review) Patient appeals, providing medical records showing BMI 38, hypertension, and prediabetes Appeal denied with explanation: "Anti-obesity medications are not covered benefits" Patient switches to cash-pay compounded semaglutide at $297/month The second most common pattern: Patient has type 2 diabetes, A1C 7.8%, currently on metformin 2,000 mg daily Provider submits prior authorization for Ozempic with complete documentation Ambetter requests additional information: "Please provide documentation of 90-day metformin trial" Provider resubmits with pharmacy fill records showing 120 days of metformin Approved, but patient is on Bronze plan with $5,000 deductible Patient pays full Ozempic cost ($968.52 per pen, 30-day supply) until deductible is met After 5 months and $4,842 in out-of-pocket costs, deductible is met and copay drops to $350/month Patient calculates that 12 months of compounded semaglutide ($3,564 total) costs less than 6 months of brand Ozempic before hitting deductible The third pattern (less common but notable): Patient has type 2 diabetes and obesity, qualifies for Ozempic Prior authorization approved Patient is on Silver plan, Tier 3 copay is $200/month Patient loses 35 pounds over 6 months, A1C drops from 8.1% to 6.3% Provider documents diabetes as "well-controlled" in chart Ambetter reviews ongoing authorization at 12-month mark Ambetter denies continued coverage because A1C is now below 7.0% Patient regains 18 pounds over 3 months after stopping semaglutide A1C rises back to 7.4%, coverage reinstated This third pattern reveals a perverse incentive: successful treatment leads to loss of coverage, which leads to disease recurrence, which restores coverage

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Besides, the expression of TF in peripheral blood monocytes induces intravascular thrombosis during sepsis as well (233)

doi: 10.3389/fnins.2021.726476 137 WangJ.ChengQ.FangJ.DingH.LiuH.FangX.et al