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Per-milligram peptide cost is typically identical whether you purchase one 20mg vial or four 5mg vials, but the effective cost differs dramatically when you account for potency loss

Investigation and Evidence Gathering Evidence Collecting: Legal teams collect critical documentation including: Complete medical records from ophthalmologists and prescribing physicians Pharmacy records establishing drug usage timelines Expert medical opinions linking GLP-1 drugs to specific vision conditions Scientific literature and FDA adverse event reports 3

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There were no claims available for HCPCS code C9791 when we were setting rates for CY 2025, so we continued to assign HCPCS code C9791 to APC 1551 (New TechnologyLevel 14 ($1201-$1300))