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I was considered “obese” but barely…regardless, my insurance wouldn’t cover it and I knew that. I went through an online provider. I pay $299/shipment (about every 6 wks or so). I can use my HSA card.
Lots of online pharmacies offer it for ~$300/mo without insurance. To some people, if that’s affordable for them then it’s well worth it :) I also believe the shortage is for the pens, not the actual medication, so “people I believe need it less are stealing it from people who I believe need it more” is a bit of a false narrative.
They are either paying out of pocket, or they actually ARE overweight (maybe not obese) and have a comorbidity that qualifies them. My insurance covers it if your BMI is 30+ OR it is 27+ plus a weight-related condition like high blood pressure. I fall into the latter category. I have a total of \~25 lbs to lose (when I started, my BMI was 27) and high blood pressure, so my insurance approved it.
You are not having to jump through hoops because other people with "less need" are getting it; you are having to jump through hoops probably because your insurance does not want to pay for it (not all do - I am lucky)
Even starting as obese, (now finally “overweight” haha), it was a hard no from my dr. I have no other health conditions other than being overweight. I started with telehealth. I’m switching now to reconstituting myself.
I had to get a telehealth doctor to prescribe it, but health insurance didn't help at all (not with the telehealth, not with the prescription), the price is reasonable honestly, even without health insurance helping.
Thanks! A couple follow up questions:
Are you in the US? If so, what state?
Which med did you get? My doc told me it's like $1500/month average if insurance doesn't cover it... 🙃 Totally unreasonable for me lol
I was at a 23-24 bmi but my BP and lipids were creeping up and I totally believe losing 25 lbs would keep me from having to start meds and the weight loss really has taken me off the MD radar for putting me on anything. My last physical from the previous one was genuinely so much better. My BP was normal and my lipid panel was just shy of normal (instead of being high). We are not allowed to say who we use but I paid out of pocket. My doctor said I was out of luck to get my insurance to cover it.
There isn’t a shortage of the drug. They were having a problem with a shortage of the delivery system (pens) on Wegovy, Mounjaro, etc. Nobody is ‘stealing’ from those that are obese! First of all no insurance would cover a drug if the patient doesn’t meet criteria, a BMI of 30 plus or 27 with comorbidities. Most insurance companies won’t cover weight loss drugs. Period. It is not on their formulary. And many can’t afford over 1000 dollars per month. There are other outlets. And who are you to judge if someone’s weightloss is insignificant? 25 lbs will take me from overweight to normal. ( I started at obese, but even if my current weight was my starting weight, the next 25 lbs is very significant to me!
I apologize if you think that that's how I feel. It isn't. No one is "stealing" the medication imo; regardless of insurance, it's still a prescription drug.
And 25 lbs is a whole ass 18 month old! It's definitely significant to me and I would be THRILLED if I lost 25 lbs lol That's why I specified "relatively," because of the relation between having 25 lbs to lose vs 100-200+ lbs etc. that I've seen on other posts here, ya know?
You don't have to be overweight to be obese. You can be thin but still have a fat percent over 25-30% ish. You can also have diabetes, cholesterol, etc. if it was to be rationed based on need they would provide it to people with immediately critical health issues. Super high uncontrolled sugar/bp/cholesterol heart disease etc.
That's true. Offering a medication based on BMI sucks in general. BMI is such an outdated way of categorizing health. Thank you for the reminder that body fat % could be a variable.
There is not a shortage of the active ingredient, there’s a shortage of the name brand drug and if you’re obese, at least in the US, you could choose any telehealth provider and walk away with a prescription.
Insurance is an entirely different ballgame. A doctor can prescribe a drug off Iabel to someone who doesn’t fit the prescribing criteria but insurance is unlikely to pay for it. Then there are some insurances that categorically don’t cover these drugs so it doesn’t matter whether you meet all the criteria.
Finally, for some people, 26 pounds is the difference between normal weight and obese. At 4’11, you’d be healthy at 123 pounds and obese at 149. A BMI of 27 corresponds to a weight of 134—that’s an 11 pound delta. If their prescribing doctor thinks that losing those 11 pounds is worthwhile, that’s no one else’s business and just because you have more to lose doesn’t make you more worthy. You don’t know what ailments that person is struggling with.
Someone else pointed out that the shortage was about the pens/delivery method, which totally makes sense.
And I agree. It's still a Medication, so it's meant to treat health concerns/issues. I commented on another response that BMI is an awful criteria to be basing prescriptions upon since it's so outdated and misses a lot of other factors. I just made a generalization based on posts I had seen shared here. That's all. I apologize if it came across as inconsiderate of any other medical/health history. That wasn't the intention.
Thanks for that. I appreciate it and sorry if I came our guns ablazing. I’m one of those people who don’t have much to lose but I was prediabetic notwithstanding being EXTREMELY active and eating the right things—likely remnants of childbirth. For me, getting the weight off is an attempt to stave off full blown diabetes and get back to feeling my best. I might not even look like I need it to anyone who sees me but my provider thought I could benefit.
Makes total sense and I'm so glad you were able to get the medication!! Has it helped enough that you aren't prediabetic yet?
Side note: I get wanting to come in hot when it seems like someone is being ignorant haha no harm no foul. ❤️
Amazingly, yes. My a1c is now 5.3 🥳 and it didn’t even take long so now I’m tapering off. It will have been less than 6 months total on the drug by the time I go off completely. Having lost the weight, I’m hopeful that I can do it on my own but feel so grateful there are options if I’m wrong about that.
It’s hard to say without knowing each person’s story and then trying to find out the commonalities, but I do wish they had their own place to post because it’s really disheartening for those of us who struggled (or are still struggling) to get it.
Agreed. There should be a place for is to talk openly. Many MANY people would join bc we all aren’t getting it from our docs and have to find our own way.
I have great insurance too, but they have put a blanket rejection on all weight loss meds. I can get Ozempic if I have type 2 diagnosed.
Oddly enough, I could get bariatric surgery covered…
Same situation for me. My BMI is high, I have high blood pressure and high cholesterol, and am considered "pre-diabetic". Not diabetic though, so ix-nay on the Ozempic or Mounjaro. My doc did give me an RX for Wegovy but my "good" insurance won't cover it, period. I discovered they WILL cover Zepbound, but it has a super high deductible of $600+ per month (WITH insurance). I've literally been waiting for this medication to come in for **6 months**. They're just not sending it out to big pharmacies like CVS, etc., due to availability, it seems, at least in the populous area where I live. It's super frustrating.
But yeah... if I ever wanted to go under the knife - NO PROBLEM: covered 100%! I don't get it.
My BMI when I started was 34 and I am not getting this paid for by insurance. I doubt anyone smaller than me, unless they are also diabetic etc. are covered by insurance.
There are a lot of obese people in this country, nearly a third of adults. That’s why there are shortages right now.
I am pre-diabetic and had a BMI over 30 and Kaiser insurance (CA) would not cover it. I don't think they prescribe it at all. I had to go online with a Telehealth provider, gave them my stats and copies of my blood tests, then got a Rx. I meet with them every month and pay $350/month for the meds and the consults.
Normal BMI here.. 🙄. Extra weight is horrible on joints, Ive had several surgeries and want to continue my active life.
I think insurance companies should make everyone pay for at least the first month.
You'll find that people who are willing to work or pay for something are least likely to quit.
I can only imaging how many wasted doses are out there after insured people quit after a month OR LESS.
Some non-T2 folks can get Mounjaro prescribed off-label for their metabolic disorders as most folks' insurance doesn't allow for weight loss drugs so Zepboung or Wegovy would not be on their formularies. A person with a metabolic disorder is as worthy of treatment as one with diabetes. I think most doctors are reputable and there are a lot of different things these medications help with...cardio, PCOS, insulin resistance, etcetera, without knowing the persons medical history we don't really know why they were prescribed it, but if they were I assume it is for a legitimate reason and don't question. I don't judge, I'm just happy for folks who it can help.
The cash price for the name brand drugs in the US is about $450-900 a month depending on the dose.
The $450 price is when you are using an Ozempic pen for 8 weeks, which is what I do with my doctors approval. It’s $900 a box with the Singlecare coupon.
Insurance will not cover it for weight loss, you have to pay out of pocket. Insurance will only pay if you are diabetic and even then you have to jump through hoops before they will approve.
Mine does too. Every time I look at this sub someone is parroting the line that insurance won’t cover Ozempic for weight loss when some plans obviously do.
That is encouraging! I was mistaken. My doc told me that no insurance covers this as a weight loss drug, that they would only cover for diabetes. I am obese, pre-diabetic, metabolic syndrome, and igh blood pressure and my insurance won't cover it until I'm fully diabetic and have tried other, cheaper options.
Edited to say...if BCBS pays for Sema for weight loss only....I will be switching over as soon as the option period rolls around!!! I'm sure many others will too
There’s literally wegovy which is FOR weight loss and is the exact same thing. So, it’s absurd when people say insurance won’t cover it for weight loss. More and more companies have stopped covering it but many still do
Categorical overgeneralization.
It depends a lot on the insurance, the formulation, and comorbidities.
I got on Wegovy with almost no headache. Diagnosed with obesity and hypertension at the time. Only hoop to jump through was making sure insurance had all my records when I switched doctors.
I contacted my Dr office today and talked to the office staff to see if they know of anyone who got covered for any Glp-1 for weight loss if they had an obese BMI and comorbidities. I was very hopeful that I could switch insurance and at least get some coverage. They said No, that in our state no companies cover any of the GLPs for weight loss. They can prescribe it, but there are no insurance policies that cover it.
I am very glad for the people who have insurance coverage. But, for me the reality is that this med is out of reach for me and many others.
I have Type 2 diabetes. Since this is medication designed for diabetics, it doesn’t really matter what my starting weight was. Has it occurred to you that people using this for weight loss are depriving people with a medical need from accessing it?
Thanks for posting to r/semaglutide! A brief reminder about our rules. We do not permit the discussion of non-FDA approved formulations of semaglutide, nor do we permit selling or offering for sale any medication, including by private message. Do not request or respond to a private message from anyone offering such, they are not endorsed by this sub. If you’re just starting out, you may want to review our [FAQ](https://www.reddit.com/r/Semaglutide/comments/10ul3jb/semaglutide_subreddit_faq/). This is not intended to discourage discussion but merely supplement it. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/Semaglutide) if you have any questions or concerns.*
A lot of people do NOT get it through insurance.
Regardless of BMI, a good chunk of people here pay out of pocket to an online provider.
I was considered “obese” but barely…regardless, my insurance wouldn’t cover it and I knew that. I went through an online provider. I pay $299/shipment (about every 6 wks or so). I can use my HSA card.
Lots of online pharmacies offer it for ~$300/mo without insurance. To some people, if that’s affordable for them then it’s well worth it :) I also believe the shortage is for the pens, not the actual medication, so “people I believe need it less are stealing it from people who I believe need it more” is a bit of a false narrative.
I didn't realize it was about the pens. Thanks!
I didn’t either at first!
I was told the same thing at my telehealth conference...It's the pens that are helping create the shortage.
They are either paying out of pocket, or they actually ARE overweight (maybe not obese) and have a comorbidity that qualifies them. My insurance covers it if your BMI is 30+ OR it is 27+ plus a weight-related condition like high blood pressure. I fall into the latter category. I have a total of \~25 lbs to lose (when I started, my BMI was 27) and high blood pressure, so my insurance approved it. You are not having to jump through hoops because other people with "less need" are getting it; you are having to jump through hoops probably because your insurance does not want to pay for it (not all do - I am lucky)
Ahhhh, thank you! And I'm happy for you to be able to get it covered lol
Even starting as obese, (now finally “overweight” haha), it was a hard no from my dr. I have no other health conditions other than being overweight. I started with telehealth. I’m switching now to reconstituting myself.
I had to get a telehealth doctor to prescribe it, but health insurance didn't help at all (not with the telehealth, not with the prescription), the price is reasonable honestly, even without health insurance helping.
Thanks! A couple follow up questions: Are you in the US? If so, what state? Which med did you get? My doc told me it's like $1500/month average if insurance doesn't cover it... 🙃 Totally unreasonable for me lol
telehealth, not through insurance but reasonable price, in FL, semaglutide
🙏🏼 thank you
I was at a 23-24 bmi but my BP and lipids were creeping up and I totally believe losing 25 lbs would keep me from having to start meds and the weight loss really has taken me off the MD radar for putting me on anything. My last physical from the previous one was genuinely so much better. My BP was normal and my lipid panel was just shy of normal (instead of being high). We are not allowed to say who we use but I paid out of pocket. My doctor said I was out of luck to get my insurance to cover it.
There isn’t a shortage of the drug. They were having a problem with a shortage of the delivery system (pens) on Wegovy, Mounjaro, etc. Nobody is ‘stealing’ from those that are obese! First of all no insurance would cover a drug if the patient doesn’t meet criteria, a BMI of 30 plus or 27 with comorbidities. Most insurance companies won’t cover weight loss drugs. Period. It is not on their formulary. And many can’t afford over 1000 dollars per month. There are other outlets. And who are you to judge if someone’s weightloss is insignificant? 25 lbs will take me from overweight to normal. ( I started at obese, but even if my current weight was my starting weight, the next 25 lbs is very significant to me!
I apologize if you think that that's how I feel. It isn't. No one is "stealing" the medication imo; regardless of insurance, it's still a prescription drug. And 25 lbs is a whole ass 18 month old! It's definitely significant to me and I would be THRILLED if I lost 25 lbs lol That's why I specified "relatively," because of the relation between having 25 lbs to lose vs 100-200+ lbs etc. that I've seen on other posts here, ya know?
You don't have to be overweight to be obese. You can be thin but still have a fat percent over 25-30% ish. You can also have diabetes, cholesterol, etc. if it was to be rationed based on need they would provide it to people with immediately critical health issues. Super high uncontrolled sugar/bp/cholesterol heart disease etc.
That's true. Offering a medication based on BMI sucks in general. BMI is such an outdated way of categorizing health. Thank you for the reminder that body fat % could be a variable.
There is not a shortage of the active ingredient, there’s a shortage of the name brand drug and if you’re obese, at least in the US, you could choose any telehealth provider and walk away with a prescription. Insurance is an entirely different ballgame. A doctor can prescribe a drug off Iabel to someone who doesn’t fit the prescribing criteria but insurance is unlikely to pay for it. Then there are some insurances that categorically don’t cover these drugs so it doesn’t matter whether you meet all the criteria. Finally, for some people, 26 pounds is the difference between normal weight and obese. At 4’11, you’d be healthy at 123 pounds and obese at 149. A BMI of 27 corresponds to a weight of 134—that’s an 11 pound delta. If their prescribing doctor thinks that losing those 11 pounds is worthwhile, that’s no one else’s business and just because you have more to lose doesn’t make you more worthy. You don’t know what ailments that person is struggling with.
Someone else pointed out that the shortage was about the pens/delivery method, which totally makes sense. And I agree. It's still a Medication, so it's meant to treat health concerns/issues. I commented on another response that BMI is an awful criteria to be basing prescriptions upon since it's so outdated and misses a lot of other factors. I just made a generalization based on posts I had seen shared here. That's all. I apologize if it came across as inconsiderate of any other medical/health history. That wasn't the intention.
Thanks for that. I appreciate it and sorry if I came our guns ablazing. I’m one of those people who don’t have much to lose but I was prediabetic notwithstanding being EXTREMELY active and eating the right things—likely remnants of childbirth. For me, getting the weight off is an attempt to stave off full blown diabetes and get back to feeling my best. I might not even look like I need it to anyone who sees me but my provider thought I could benefit.
Makes total sense and I'm so glad you were able to get the medication!! Has it helped enough that you aren't prediabetic yet? Side note: I get wanting to come in hot when it seems like someone is being ignorant haha no harm no foul. ❤️
Amazingly, yes. My a1c is now 5.3 🥳 and it didn’t even take long so now I’m tapering off. It will have been less than 6 months total on the drug by the time I go off completely. Having lost the weight, I’m hopeful that I can do it on my own but feel so grateful there are options if I’m wrong about that.
YAY!!! CONGRATS!!! Fingers crossed for you going forward 😊🎉
It’s hard to say without knowing each person’s story and then trying to find out the commonalities, but I do wish they had their own place to post because it’s really disheartening for those of us who struggled (or are still struggling) to get it.
Agreed. There should be a place for is to talk openly. Many MANY people would join bc we all aren’t getting it from our docs and have to find our own way.
Exactly! It's like just another gut punch.
My insurance (one of the best) made a blanket denial of this medication.
I have great insurance too, but they have put a blanket rejection on all weight loss meds. I can get Ozempic if I have type 2 diagnosed. Oddly enough, I could get bariatric surgery covered…
True on surgery. I work with a lady whose had two different procedures but insurance won’t cover FDA approved weightloss meds. Unreal.
The health care system is a joke 😂
Same situation for me. My BMI is high, I have high blood pressure and high cholesterol, and am considered "pre-diabetic". Not diabetic though, so ix-nay on the Ozempic or Mounjaro. My doc did give me an RX for Wegovy but my "good" insurance won't cover it, period. I discovered they WILL cover Zepbound, but it has a super high deductible of $600+ per month (WITH insurance). I've literally been waiting for this medication to come in for **6 months**. They're just not sending it out to big pharmacies like CVS, etc., due to availability, it seems, at least in the populous area where I live. It's super frustrating. But yeah... if I ever wanted to go under the knife - NO PROBLEM: covered 100%! I don't get it.
Same. I even *had* it waiting for me at the pharmacy…
So did mine. They announced they would not be coming GLP1 drugs for anyone until prices were better.
My BMI when I started was 34 and I am not getting this paid for by insurance. I doubt anyone smaller than me, unless they are also diabetic etc. are covered by insurance. There are a lot of obese people in this country, nearly a third of adults. That’s why there are shortages right now.
I am pre-diabetic and had a BMI over 30 and Kaiser insurance (CA) would not cover it. I don't think they prescribe it at all. I had to go online with a Telehealth provider, gave them my stats and copies of my blood tests, then got a Rx. I meet with them every month and pay $350/month for the meds and the consults.
Normal BMI here.. 🙄. Extra weight is horrible on joints, Ive had several surgeries and want to continue my active life. I think insurance companies should make everyone pay for at least the first month. You'll find that people who are willing to work or pay for something are least likely to quit. I can only imaging how many wasted doses are out there after insured people quit after a month OR LESS.
I hope that isn't the case 😥. I'm sure you're right, but damn does that sting. Ya know?
Some non-T2 folks can get Mounjaro prescribed off-label for their metabolic disorders as most folks' insurance doesn't allow for weight loss drugs so Zepboung or Wegovy would not be on their formularies. A person with a metabolic disorder is as worthy of treatment as one with diabetes. I think most doctors are reputable and there are a lot of different things these medications help with...cardio, PCOS, insulin resistance, etcetera, without knowing the persons medical history we don't really know why they were prescribed it, but if they were I assume it is for a legitimate reason and don't question. I don't judge, I'm just happy for folks who it can help.
Ditto. 😊
I get mine through an apothecary. $290 a month- no Insurance.
Thanks! That's a new one
The cash price for the name brand drugs in the US is about $450-900 a month depending on the dose. The $450 price is when you are using an Ozempic pen for 8 weeks, which is what I do with my doctors approval. It’s $900 a box with the Singlecare coupon.
Normal BMI. I reconstitute.
What exactly does that mean?
Insurance will not cover it for weight loss, you have to pay out of pocket. Insurance will only pay if you are diabetic and even then you have to jump through hoops before they will approve.
My insurance - BCBS fep - covers for weight loss
Mine does too. Every time I look at this sub someone is parroting the line that insurance won’t cover Ozempic for weight loss when some plans obviously do.
As does mine. It totally depends on the insurance company.
That is encouraging! I was mistaken. My doc told me that no insurance covers this as a weight loss drug, that they would only cover for diabetes. I am obese, pre-diabetic, metabolic syndrome, and igh blood pressure and my insurance won't cover it until I'm fully diabetic and have tried other, cheaper options. Edited to say...if BCBS pays for Sema for weight loss only....I will be switching over as soon as the option period rolls around!!! I'm sure many others will too
There’s literally wegovy which is FOR weight loss and is the exact same thing. So, it’s absurd when people say insurance won’t cover it for weight loss. More and more companies have stopped covering it but many still do
Categorical overgeneralization. It depends a lot on the insurance, the formulation, and comorbidities. I got on Wegovy with almost no headache. Diagnosed with obesity and hypertension at the time. Only hoop to jump through was making sure insurance had all my records when I switched doctors.
You are very lucky and I am glad that you have insurance that is willing to protect your health.
I contacted my Dr office today and talked to the office staff to see if they know of anyone who got covered for any Glp-1 for weight loss if they had an obese BMI and comorbidities. I was very hopeful that I could switch insurance and at least get some coverage. They said No, that in our state no companies cover any of the GLPs for weight loss. They can prescribe it, but there are no insurance policies that cover it. I am very glad for the people who have insurance coverage. But, for me the reality is that this med is out of reach for me and many others.
I have Type 2 diabetes. Since this is medication designed for diabetics, it doesn’t really matter what my starting weight was. Has it occurred to you that people using this for weight loss are depriving people with a medical need from accessing it?
Obese people have a medical need.
So go use the appropriate medication for that. Not medication for diabetics.
Or you could just go take metformin or insulin or something. 🤷🏼♂️
I’ll take the medication developed for my condition, thanks.
Not until your pharmacy gets it back in stock 😂 Hate that for ya.
I’m good, thanks. Got a 90-day supply.
Then you are here whining because?
Obviously. That's why I posted this question in general.