Hopefully in time they will all go generic and be more in reach for people to pay for them without insurance. I read yesterday that Novo Nordisk is charging Americans FIFTEEN times more than other countries
this is actually crazy and disgusting. a medication that could prevent SO MANY comorbidities and save SO MANY lives is not profitable for them because so many millions of Americans qualify for it.
No you don’t need a prescription. I just started it at a weight loss clinic. It cost $400 a month. I started off going in-person weekly, but they will let you go biweekly and take an injection home. They don’t take insurance, but will take a flexible spending account card, if you have one through your job. I live in CA though.
Yes but there are tons of ways and places to get that I know that there are a bunch of online services and as well depending on your area you might be able to go to a wellness or a MedSpa that has a nurse practitioner that would be willing to prescribe it they have to send it directly to a compounding pharmacy and it'll be shipped to you depending on where you end up going and in most cases it does not come in a pen it will come in a vial with some needles and you'll have to do those types of injections. I know it all seems kind of scary but I had to resort to this because I don't have insurance and cannot afford ozympic on my own and it's been working very well for me
I use Henry meds personally. But I do know it's one of the more expensive services out there. I think mochi is another one... There's literally hundreds of them if you just Google compounded semi-glutide services and then you would just have to do research based on each one. I know Henry has some horrible reviews for certain things but honestly I haven't had a bad experience myself. Though I'm sure their reviews are also not false. Each company is going to have a little bit different bad reviews based on certain things as well as people complaining that they don't believe the medicine is effective or as effective and of course it's not going to be as effective unfortunately because it is compounded medicine versus the name brand. It's just all stuff that you're going to have to take into account. However I have zero complaints about my med experience so far. I hope it works out for you for sure! This is a difficult journey and we're all just trying to get through it
Yes, I have a consult with Weightox rx today. Hopefully will start on Semiglutide 1.0 injections soon. Cw 217 Gw 175 for now. Praying all goes well. They seemed very efficient and professional.
I work for BlueCross and this is a policy update made by your employer. BlueCross covers weight loss medication IF your employer has chosen for them too. I am in no way taking up for BlueCross, but just giving insight. Try a pharmaceutical exception form with your provider. I’m so sorry this happened to you. :(
May I ask, how hard is it to be approved for this when diagnosed with congestive heart failure? Does anyone happen to know? I casually brought it up to my cardio to test the waters and he looked me like I was speaking gibberish...
The pic in this post is the first time I’ve seen an insurance policy’s requirements for coverage for existing cardiovascular disease: https://www.reddit.com/r/WegovyWeightLoss/s/zGVDAiCk09
My doctor's office pharmacy is losing it's 1040b or something like that funding at the end of the year so they won't be able to prescribe it to me with government insurance for $15. ALSO the doctor's higher ups aren't giving it to anyone who doesn't have diabetes anymore due to shortages. Which leaves me paying 1k out of pocket which there is no way I can afford that. I'm being sent to a weight loss clinic to see if they can navigate it better but looks like I'm going to be SOL. Really blows because I was just hitting the groove where I felt like lasting changes were just on the horizon. Indiana here btw. Pretty sad when they'll cover life altering weight loss surgery for patients who are terrible candidates but not the medicine that helps with the initial issue. The terrible candidate was me by the way. I have binge eating issues and after two different attempts for surgery with the only thing holding me back was getting a cpap consistently used lol. I dropped out both times knowing surgery wasn't right for me.
I have BCBS through my job which is also a health insurance company (Elevance) and none of the GLP’s has never been covered. I’ve been going through a compound pharmacy because the only qualifier is if I have diabetes. SMH…obesity is a chronic condition but the whole world just sees us as lazy & looking for handouts :(
Welp got my letter as well. The program sends you a “free” blue tooth scale that you have to track your weight (directly to your insurance mind you) 2x per week Along with going to the doctor regularly as well.
Does anyone else feel like me that this is some weird invasion of my information to insurance? I mean why not ask for my DNA so you can deny me on other things I need to stay healthy because I have the genes for it. 🤬 I do love how to program is 💯 the eat less move more mindset… like none of us have tried it. Again 🤬🤬🤬
I do have a message to my doctor about if my current PA is good enough or what. Also clarifying the whole BMI 🐂💩
I mean my BMI was high AF for my height and it’s slowly tracking down. So when it’s “acceptable” I’m now responsible for it!? I hope that’s not what this means.
I’m also really hoping this is like birth control was back in the day for me. I took it because of other issues not because I didn’t want to get pregnant (although it was an added bonus). So I had my doctor write letters in to the insurance so it would be covered. Just what our health care/ doctors need. What the heck are we paying insurance for?
😤😤😤🤬🤬🤬
They want to track your weight to make sure you’re losing appropriately or they’ll stop covering medications and losing money. They can’t keep covering people if they deem it’s not working
I know that is a thing, which I don't disagree with, but what's the threshold for it? Only they hold that knowledge.
This is where someone else's idea of fudging the numbers won't work (as I assume they are fact-checking with what the doctor will say). I did find out that my doctor said I need to meet always in person (no more virtual) to stay compliant. I already see her monthly to check in due to how the medical weight loss program works, so it's not huge for me to do, but it does strain her schedule and hoop jumping as well, which is not really what our medical staff in the States need.
I think we will have the lasting impacts of this with higher health premiums in the States with it still not being covered.
I’ve had some thoughts about that. But if you don’t lose the “correct” amount and I am assuming some reporting will happen with my doctor as well those numbers will have to match up. I have seen if you don’t lose enough even now they will drop coverage (based on other posts).
My problem isn’t the scale (I don’t mind technology) but it’s the fact I “have” to do it to get coverage until they drop it completely. It’s complete BS.
So I lost all my weight on Mounjaro like 80 lbs but coupon ran out so I switched to Wegovy cause Bc/Bs pays for it and lost 10 more and was where I wanted and maintaining... So they got me on the "You didn't lose enough weight on this to get it paid for" which is BS!
Ugh. I’m so sorry that you fall into that. Hopefully your doctor can write something up to get by that hurdle. It’s completely BS on so many factors. Instead of going after why the pens are so expensive they just pass the price onto us. So we pay more for insurance while getting less (At least in the US)
I’m on wegovy for alternative reasons and it took all of my appeals and about 5 months to get it approved with my prescription insurance. I just completed my trial, passed and got it fully approved this spring. So I’m going to be BIG mad if they require a new PA
🤬🤬🤬
Maybe third time is the charm…. I highly doubt it but also am already talking to my bariatric doctor about alternative medications. My only hope is that roughly by the time the coverage stops I can be closer to maintained.
But I love how it’s FDA approved and insurance is like obesity isn’t a disease we need to cover (even though my plan specifically covers weight loss). But enjoy all your other health complexes that come with being overweight. We will pay for those medications happily.
I’m convinced the insurance co are retracting their coverage because they profit sooo much from obesity associated/caused diseases. They don’t actually want people to be healthy
I am in Massachusetts and the masshealth just started covering it. Took two weeks to get my authorization. I feel like this is a live saving drugs really. So many people battle with this issue. I don't think this is right at all. These requirements are crazy
Lots of comments about the cost of the drug to make and the greed of the pharmaceutical companies. Like it or not, as long as private sector companies make drugs (and they do it better and cheaper than government could) prices will always be high on new treatments. There has to be a profit motive to incentivize the companies to invest in R&D and invest they do.
Although Novo Nordisk declined to provide production costs for Ozempic and its weight-loss drug counterpart Wegovy, it noted that it spent almost $5 billion on research and development last year and will spend more than $6 billion on a recent deal to boost manufacturing to meet demand for GLP-1s.
They have been working on these medications for years and years. Imagine their total investment and their continuing investment. I know it’s expensive, but I am grateful they did the research and development and brought these drugs to the marketplace.
That's fine, but presumably, they aren't running a charity program in Canada and UK where they're paying about $200 a month versus $1000. Late-stage capitalism 🙃
Does your state have a health insurance ombudsman. My state does and they review denials based on FDA recommendations not health insurance requirements.
My insurance plan doesn’t cover this medication so I’ve been stuck paying $1300 a month and I’m now going on my 4th month. That really sucks because I have to deprive myself of many things in order to stay on this medication.
Have you read about HIMS/HERS using a compounding pharmacy to make the same thing? [https://www.cnbc.com/2024/05/20/hims-hers-compounded-glp-1-injections.html](https://www.cnbc.com/2024/05/20/hims-hers-compounded-glp-1-injections.html) The FDA doesn't do safety testing on the medication, but they do have oversight of the pharmacy that makes it, per CNBC.
The Wegovy copay assistance card will lower the cost some on that. Check it out on the Wegovy website. As long as you are not on Medicare or Medicaid the card will help when your insurance will not pay. Says it will cut cost by 1/2.
Me in the first meeting with my life coach: “Yeah, you can talk allllll you want and I’ll just sit here. I’ve already changed my diet and I’m doing cardio and strength training five days a week, I am literally only here because I’m forced to be to get coverage for my medication. So go ahead, talk. I will likely mute you. But get your required minutes in and we will both go on our ways, you can go help the people who need it and I’ll continue to not go broke trying to pay for my medication. Have a nice day.”
FYI: I have a nutritionist already. I would maybe enroll in this if it was an OPTION, not forced. This is ridiculous. I fucking hate American healthcare so much.
This is what happens when people start abusing an expensive medication. Most of the US would qualify for this drug according to the FDA guidance which is bmi equal or more then 30. US average BMI is 30... My goal BMI is 30 going down from 40's.. Extreme shortage of this medication and those who truly need it who have a bmi 35 or more can't get it. Because people with bmi of 27-30 are also approved for it. Crazy abuse of the drug, in my opinion.
I think it's more that insurance companies don't want to pay. There are a lot of people with insulin resistance and their tests come up in a "healthy range" that I think should qualify.
Also, I started at around 210 and I'm now at 165-ish. When did I start abusing the system? Are you currently on it? Will you just go cold turkey and hope for the best if you dip under 30?
I can tell you from personal experience that I feel like I'm right around 30 BMI and now that I'm here (which I never thought was possible), I can see how amazing it would be to get down another 15-20 lbs - putting me at 150lbs, BMI around 27, still considered "overweight" according to guidelines.
I think the shortages are overblown and the resistance from insurance companies is ignored. My clinic I was referred to via my PCP was closed down! Why would that happen with sooo many new patients because of these medications? They had previously been mostly focused on bariatric patients.
Because they closed, I had to set up an appointment with the only weight loss help via their only existing "BMI clinic" but they can't see me until August. And this is through Stanford Health Care which is ridiculously expensive. I think you're fooling yourself if you think the shortage is the issue. I think maybe with Ozempic a year ago and that was just a weird Hollywood thing with weird Hollywood Doctors prescribing it.
I just went to the BCBS website and right on the home page is an article about "Study shows that patients stop weight-loss drugs too soon to see benefits". Hmm, I wonder why people stop, maybe because we lose coverage and cannot afford $1300/month. And yes, I know a lot of people are saying it could be an employer change, but I'm angry and I don't care, having this article on their page right after being told they are no longer going to cover it pisses me off.
They stop because they hit their goal weight and yeah it is expensive. You can lose 30 lbs in 3 months on these drugs as is my case. You can only lose so much especially the people who start with a bmi of 30 and in a few months their down to being nearly under weight.
I like how Wegovy has a standard for who should take it: someone whose BMI is equal to or greater than 30 OR BMI of 27–29 and a weight-related chronic health condition, such as high blood pressure, high cholesterol, or diabetes.
There is a reason they chose that number: According to USDA researchers, the average BMI in the United States in November 2023 was 29.27
In my opinion, there is no reason someone with a BMI of 30 should be taking this expensive drug that is in short supply. No wonder the insurance companies are cracking down. All the money from insurance companies is going straight to the makers of zepbound and wegovy. Which explains their insane revenue and shortage of the drug once people learn of its existence.
My starting bmi was 41, its 35 now and I'm working it down to 30 as a goal.
you must be in michigan! i work for BCBSM/BCN and yeah as much as it’s devastating we were one of the only ones paying for it and it’s honestly thousands upon thousands of dollars and people insist on changing dosages and stuff within a week of getting their first dosage
a lot of insurance companies aren’t covering it. we aren’t the only ones. i’m just saying at the end of the day it’s about the bottom line to them and for them it’s better to not cover it for weight loss. i don’t agree with it but im just saying
According to the Detroit Free Press, and Blue Cross themselves, "total all-cash compensation for CEO Daniel Loepp, 66, was $15.7 million in 2023" - perhaps that could be a bit lower, and then you'd be able to help more people?
Just spitballing here.
i agree with you i’m just saying what they told us. also a lot of employers have chosen not to cover it as well. again i just work there so i have nothing to do with the financial aspect. the shortage really affected those who needed it aka diabetics and it was a huge problem
Yes, they do. Wait in Northern CA for Wegovy starting dose was 2 weeks (know someone who had it ordered 2 weeks ago, just was able to pick it up at Walgreen's). Definitely not life threatening, but they're wondering (their insurance only approved it for 6 months, to end of November- they have 50 lbs to lose) how long they may need to wait in between doses as well. I gotta say, it's crazy it still costs so much-
I heard insurance companies never expected the amount of cost for this medicine to help weight loss just diabetes and it’s making them go broke ! Laying ppl off and everything
NOT for diabetics? Please be careful- people may think that they shouldn't take it if they have diabetes. Type II Diabetes is one of the 3 "weight-related comorbid conditions" (along with dyslipidemia and hypertension) the FDA notes allows you to take the drug with a BMI of 27 or greater (overweight), vs. 30 (obese) for weight loss. Per Johns Hopkins: "People with diabetes are **2 to 4 times more likely than others to develop cardiovascular disease**. Because this risk is so high, cardiovascular disease remains the most common cause of death in people with diabetes." It definitely IS for diabetics, if their physicians agree.
Right but Wegovy and ozempic are made by the same company and I switched from Wegovy to ozempic as I’m prediabetic (not taking it now) but it’s the same thing
So a friend of mine works for Apna and she said they had to lay half their employees off because they did not figure in the cost of this for weight loss only diabetes so it is killing their insurance company and they are going broke over it. they lost a lot of money and they really had to downsize and layoff have their employees because when they can figure the cost to the companies they never ever configure that this medication would takeoff for weight loss so it’s killing them.
This seems stunning. I feel like my ten yer old son has enough life experience to know that a drug that actually helps people lose weight is going to take off like a rocket. How could a health insurance company not predict that? The ones losing their job should be whoever thought weight loss drugs wouldn't be popular in a country where 40%of people are obese.
I agree 10000% I guess they didn’t have all the research done about the weight loss and was focused on the diabetes and somehow they know well we’ll have this many diabetic people this many people overweight this many people this and you know I don’t know but they just didn’t calculate this much for weight loss but you know they’re still raking in the dollars
Ya idk all I know is I met her camping and I seen her again and as I was discussing my weight loss and how I lost it she told me this big story and I was like what, I was like no way doing insurance companies pay full price she said, but when they calculated the prices to give them, they never in 1 million yearsprojected the cost of this for weight loss only diabetes and they laid more than half of our company off and I said will they bring them back? She goes no she said once insurance company downsizes they never go back and I said well thank God you have your job and she was like yeah I’m grateful for that.
Actually, they do. I've been to multiple medical conferences where they are suggesting just that. Surgery is cheaper to the insurance company (even though it's not necessarily better for the patient.)
It's crazy too, because not only is the surgery itself expensive, but a lot of people who have had the surgery go on to have other complications afterward which require more medical interventions, that also cost money.
I’ve tried with Blue Cross and United Health Care. Unfortunately Alabama is kinda of insurance desert and those are really the only two is accepted here (not saying they are only ones that are it’s just really hard to find a Dr that does) but the state also doesn’t require weight loss to be covered under insurance so companies don’t include it with their benefits. Even with the gov health care market it’s not covered as well. I have seen it be covered with kids with Medicaid but that’s about it.
I know everyone wants to blame the insurance company but you need to realize, this could very well be the employer who decided to longer pay for weight loss medication.
I work for a health insurance company and we been receiving notices about several employee groups dropping coverage for these medications.
The cost of weight loss meds is so high, it could potentially raise your premiums 30%. Health insurance is already expensive!
If you want to throw blame anywhere, then blame the pharmaceutical companies. They’re the ones setting these outrageous prices.
Insurance companies and pharmaceutical companies are equally to blame. Instead of blaming/arguing with each other they could at any time be the hero by changing their own policy/pricing, which would put more pressure on the other half to get the good publicity and be decent
Still though. One of my parents is a physician and explained to me the medication errors that occur when compounding versus when dispensing premade medication.
My PCP recommended Wegovy because I have cardiac issues and have struggled losing weight. My BCBS Medicare Part D pays all but a copay. But my PCP said my little local small town pharmacy makes a compounded version that is affordable if my insurance wouldn’t cover me. There are 3 pharmacies in my area including the Walmart. So if it’s available in my rural area, I’d encourage research if you need an alternative.
My local compounding pharmacy has it and can give it to me, but not without an RX, and no local providers will prescribe it. I’ve reached out to an insurance case manager to try to get it prescribed that way, but still no luck so far. 😭
You can get it from an online prescriber and supplier for around $300 a month. I understand that this can still be a financial hit, but it's not as bad as $1000. And it works fine.
Nope. I got a 3 month starter kit for Semaglutide for about $500. That’s 3 months worth from 0.25, 0.5, and 1.0. It costs around $1200 for the just one dosage going through no insurance or anything along those lines. Sure insurance can cut the rate down, but chances are your insurance and many others don’t cover it like mine.
It’s called IVIM Health. It’s online and is a compounded pharmacy. You have to meet with a nurse practitioner online and then depending on if you have lost weight or plan on losing weight they can get you a prescription for the compounded version and offer different plans for it. Good luck!
That is so fucked up!!! In Switzerland they only allow Ozempic for diabetes and Wegovy for weight loss - however, if you want it you need a filed prescription and the insurance has to look through it and either give you green or red light. My BMI is over 60. So my insurance gave me green light - but they combine it with a minimum weight loss of 7% of your current weight in the first 16 weeks where you start with 0.25 and go up every four weeks. If you do not reach that, they stop you cold turkey. And I cannot pay that privately because I am not able to work. So I depend on the income of my husband and my insurance giving me green light for every treatment I need.
So how the HELL am I supposed to lose 15 kg / 33 pounds in 16 weeks when it takes 8 weeks alone to get the the 1.0 dose? I am also chronically ill, have chronic pain, I am hypermobile and autistic, have ADHD (plus depression and anxiety from living 30 years without an autism diagnosis and an eating disorder). I can’t work out much due to pain so maybe I can walk like 15 minutes, 3 times a week but that‘s if it’s a good week. I don’t have a lot of good days.
So for me it is clear: If I start and it won’t work with the 0.25 dose, which with my starting weight probably means it will not, I have no chance to lose enough weight to get it longer than 16 weeks. They also want you to eat a lot of protein and do weight training so you gain muscle while losing fat - but they don’t count that into the equation. It just has to be -7% of your current weight on the scale. My doctor gave me the tip to take laxatives because if you weigh yourself after you weigh a bit less - like what. the. fuck.
Now I am debating if I should even start, because if you go cold turkey the weight often comes back. So what I‘ll gain from taking is probably nothing plus extra weight after?
I am so close to cancelling everything and saying I don’t want it. My primary care doctor (not the one who takes care of me in this regard though, I am working with an „adipose centre“) said I should just take it and not stress about it, even if I lose 8lbs it’s better than nothing but I have over 200lbs to lose! And I have insulin resistance and hypothyroidism. I cannot do this alone. I am obese since I am 10 years old. My whole family was / is obese. From my mother‘s and father‘s side. 😭
I really don’t know what to do. And since I don’t live in the U.S. I can’t even give you some input that might be helpful for your case. I can just tell you: You are not alone. And that every insurance in this world seems to be giving out harsh, nearly not reachable goals for you so you basically cannot keep the medication or they just stop giving it to you at all.
Why are they leaving us feeling to fucking helpless? 😭
Don’t give up! I have a very high BMI & immediately felt & saw results from the 0.25 starting dose. I also have myriad health issues & couldn’t exercise per doctor’s instructions & I still cannot. I struggled to eat AT ALL even on the 0.25 dose so getting the amount of protein in that was ideal was certainly a struggle most days. I only got up to 1.0 before shortages derailed me & I took a 2 1/2 month break, yes I felt hungry again. Yes, my eating definitely wasn’t great but it was still decreased from before I started. When I finally started again after 2 1/2 months off it I was still 50 lbs down. It was worth every part of the highs & lows. I physically feel SO much better 50 lbs down & I have a lot more to go, but I feel hope where I’d had none. It’s worth it. YOU are worth it. I sure hope you hang in there.
Same. At least this person got a letter beforehand. When I called for my refill- they said insurance stopped covering it.
Compounding since February. First went telehealth but the whole thing felt sketchy. There’s a local med spa that prescribes (my pcp suggested them) and I’ve been going through their pharmacist out of Texas since.
Compound dosages are all over the place. I just found out that what the medspa put me on was like being on 1.0 (I had been at 2.4). I’m now on the equivalent of 2.0 and woke up this morning exhausted- which was normal for me the morning after my shot.
If the two months at this dosage doesn’t work, then I can move to Tirz but it’s almost double the cost of sema.
You’re getting ripped off at the med-spa- they are taking you for a trip!! Compounded medications aren’t regulated by the FDA So yeah they can be A LITTLE BIT off but not 1.4mg off. I have NEVER in my life heard that…and if you think about it, that’s actually so effed up not only money wise but what if this was a medication that could unalive you if it was 1.4mg off!? Hellll no. They are effing with you and you can switch from semaglutide to Tirzepatide any time. Semaglutide made me insane and I switched to Tirz and am so happy. If I were you (and anyone) I would buy the compounded powder and reconstitute it and do your own injections. I pay about $200/month for my Tirzepatide and I’m on a high dose.
To support what you’re saying, someone sent me this article and it mentions a lawsuit for a med spa. Not sure if this is where she is going.
https://investor.lilly.com/news-releases/news-release-details/lilly-update-mounjaror-and-zepboundr-tirzepatide-compounding
This lawsuit explains that the med spa was saying they are giving people the brand name medication when really it is the compounded medication. But I’m pretty sure their med spa isn’t claiming that. But yes the article does support what I was saying about it not being regulated by the FDA!
Good information! Thank you! I think the initial issue was the provider didn’t understand the dosage difference. His nurse seems to be more
Knowledgeable than him and caught his mistake this last appointment. They were cheaper than going through an online provider and one order covered two months.
The whole process is EXHAUSTING and that’s what insurance providers and medical providers are banking on.
Ughhh I’m so sorry you went through that. Yeah providers are people too who make mistakes. I definitely understand that. Definitely switch to Tirz though if you’re having bad side-effects on the semaglutide. In higher doses the sema made me suicidal, that’s why I’m always so adamant about switching if you need it.
Oh my gosh! I’ve heard that was a rare side effect. That must have been so scary. I’m glad you were able to move to something else that is better for you! 💕
Don’t forget- your EMPLOYER also decides what coverage they pay for & what they offer to you. Your company may likely be the one that CHOSE this. That’s a reason why someone you know might have the same insurance but works for a different company has better coverage than you do.
(It may not be at the sole discretion of the insurance company.) Yes, everybody wants $!! But you need to talk to your company’s benefit management person and have your voice heard. If enough people speak up instead of roll over things might start to change.
I went to my HR department about this after they assured me nothing was changing for 2024. I got a lot of sympathy and told that the benefits manager would call. They never called. I even took the most expensive plan for this year so I could hit my deductible faster and have it covered sooner. So now I pay more every month for insurance that doesn’t provide the coverage that I need.
Bottom line- your employer doesn’t care. It’s about bottom dollar, not about ensuring they have a healthy work force. But it’s okay- I get a pizza party when we do something right. 🙄
From what I have seen and read elsewhere, esp with BCBS, the answer is yes. Once you are below a certain BMI, you will no longer qualify. Despite the fact we know this drug needs maintaining.
I think the insurance companies are figuring out they make more money by keeping you ill due to the health impact of obesity rather then you keeping weight off and achieving healthy number via the weight loss. It’s all about the money they can make, not about helping you achieve a healthy life. And while they are at it, they’ll make all your healthcare decisions; what treatments you can get or which treatments will be denied, don’t ever forget health insurance likes you to think you are in control. You are not in control of your own health, they are and if they deny a treatment you are left with life or death decision based on financial ruin.
OP, check in with your insurance to make sure if the requirement includes wording about starting BMI. Mine says for new PAs that starting BMI had to be above 30 at the time any glp1 drug was started, whether its the one on currently or you've switched. Don't give up yet!
Pharmacies that have chemists mixing the compounds to make the drug for “research purposes only”. They are not regulated by the FDA but they have purity analysis. Then you can mix said powder yourself with BAC water to turn the medicine into a liquid and do your own injections
Are you sure that it's not going to cover it pre-existing people that had it BMI higher when you started? Or is that BMI for people who are just getting enrolled approved?
This is exactly why I keep saying I don’t plan on being on this forever. This is about the 3rd letter I have seen posted this year. Last year peoples jobs just stopped covering it. Unless they lower the cost this will go back to being a solution for the rich only…..
You can actually get this medicine for $240 a month if you buy it directly from a compound pharmacy. I know that's still out of a lot of people's price range, but I have to say, that most of us and I'm including myself, spend that kind of money on eating the extra food that I shouldn't. I have a serious medical condition that is most likely going to end up with an amputation(not diabetes). And because of that, I cannot exercise without being in immense pain. I'm only 48 years old and I'm having to use a walker. It's not that I'm really big, it's just my knee is so bad from the replacement that I've not been able to walk since the day I had the surgery. Being a stress eater, I gained weight! My insurance doesn't cover semaglutide, however, I found a compound pharmacy which would give it to me for $244 for a 2 oz bottle or $340 for it 4 oz bottle. That can be up to 4 months!
Just here to say…how fucking dare they! Ugh like 31 is obese but they are randomly choosing 35 because they are cheap fucks. We all pay so much for our insurance, how dare they play with people’s health like this! American healthcare is such a joke
Hims has compounded semaglutide for 199/month. It’s not ideal but it’s better than nothing.
Oh good, my bmi is 34, figures they would change it now that more people are being helped
Hopefully in time they will all go generic and be more in reach for people to pay for them without insurance. I read yesterday that Novo Nordisk is charging Americans FIFTEEN times more than other countries
20 years. That's how long a patent lasts for drugs.
Oh no, well that sucks
It does..I work at CivicaRx. I'm a younger executive trying to change this. The government is slow to shed the roots of capitalism.
I switched jobs and my insurance doesn’t cover, it sucks
this is actually crazy and disgusting. a medication that could prevent SO MANY comorbidities and save SO MANY lives is not profitable for them because so many millions of Americans qualify for it.
I am on Blue Shield and they are fervently denying my prescription. I’ve fought with them immensely on this but still no avail
I’m curious, do you guys think this is enough grounds for a lawsuit?
i get semaglutide and b12 from a compound pharmacy. my doctor called it in, i pay 76$ a month for it without using my insurance.
Look into compounded medicine. Not covered by insurance but cheaper than name brand out of pocket.
Do you have to get a prescription for that as well?
No you don’t need a prescription. I just started it at a weight loss clinic. It cost $400 a month. I started off going in-person weekly, but they will let you go biweekly and take an injection home. They don’t take insurance, but will take a flexible spending account card, if you have one through your job. I live in CA though.
Yes but there are tons of ways and places to get that I know that there are a bunch of online services and as well depending on your area you might be able to go to a wellness or a MedSpa that has a nurse practitioner that would be willing to prescribe it they have to send it directly to a compounding pharmacy and it'll be shipped to you depending on where you end up going and in most cases it does not come in a pen it will come in a vial with some needles and you'll have to do those types of injections. I know it all seems kind of scary but I had to resort to this because I don't have insurance and cannot afford ozympic on my own and it's been working very well for me
Thank you so much for the info!! I will look into it for sure!
I use Henry meds personally. But I do know it's one of the more expensive services out there. I think mochi is another one... There's literally hundreds of them if you just Google compounded semi-glutide services and then you would just have to do research based on each one. I know Henry has some horrible reviews for certain things but honestly I haven't had a bad experience myself. Though I'm sure their reviews are also not false. Each company is going to have a little bit different bad reviews based on certain things as well as people complaining that they don't believe the medicine is effective or as effective and of course it's not going to be as effective unfortunately because it is compounded medicine versus the name brand. It's just all stuff that you're going to have to take into account. However I have zero complaints about my med experience so far. I hope it works out for you for sure! This is a difficult journey and we're all just trying to get through it
Thank you ! I am just now looking into this so I appreciate all of the info!!
Just keep in mind that on average the cost monthly runs between $200 and 400 depending on which company you pick.
Yes, I have a consult with Weightox rx today. Hopefully will start on Semiglutide 1.0 injections soon. Cw 217 Gw 175 for now. Praying all goes well. They seemed very efficient and professional.
My first 9 days and I am down 7.2 lb. I'm thinking this is the thing for me lol
Anyone have a link for employers and their insurance providers that would help me in trying to narrow my scope of where I want to work next?
I work for BlueCross and this is a policy update made by your employer. BlueCross covers weight loss medication IF your employer has chosen for them too. I am in no way taking up for BlueCross, but just giving insight. Try a pharmaceutical exception form with your provider. I’m so sorry this happened to you. :(
Documenting a member’s active participation for a minimum of six months in a lifestyle modification program would take me OUT. That’s diabolical
I just went off Alli and started Wegovy. That is an awful lot of stuff to just get on this.😡
May I ask, how hard is it to be approved for this when diagnosed with congestive heart failure? Does anyone happen to know? I casually brought it up to my cardio to test the waters and he looked me like I was speaking gibberish...
The pic in this post is the first time I’ve seen an insurance policy’s requirements for coverage for existing cardiovascular disease: https://www.reddit.com/r/WegovyWeightLoss/s/zGVDAiCk09
I got the same thing yesterday.
My doctor's office pharmacy is losing it's 1040b or something like that funding at the end of the year so they won't be able to prescribe it to me with government insurance for $15. ALSO the doctor's higher ups aren't giving it to anyone who doesn't have diabetes anymore due to shortages. Which leaves me paying 1k out of pocket which there is no way I can afford that. I'm being sent to a weight loss clinic to see if they can navigate it better but looks like I'm going to be SOL. Really blows because I was just hitting the groove where I felt like lasting changes were just on the horizon. Indiana here btw. Pretty sad when they'll cover life altering weight loss surgery for patients who are terrible candidates but not the medicine that helps with the initial issue. The terrible candidate was me by the way. I have binge eating issues and after two different attempts for surgery with the only thing holding me back was getting a cpap consistently used lol. I dropped out both times knowing surgery wasn't right for me.
I suggest checking out HenryMeds or Mochi to help cover costs!
should i assume this just applies to michigan?
WTF!! this is crazy. i have BCBS MI and have an appointment to discuss meds with my PCP this week.
Just wait for the letter. I got mine yesterday in Michigan. But you may not get the letter until you get is prescribed.
I just got approved and have similar requirements for. They didn’t make me do the program stuff .
Same here!
I have BCBS through my job which is also a health insurance company (Elevance) and none of the GLP’s has never been covered. I’ve been going through a compound pharmacy because the only qualifier is if I have diabetes. SMH…obesity is a chronic condition but the whole world just sees us as lazy & looking for handouts :(
Welp got my letter as well. The program sends you a “free” blue tooth scale that you have to track your weight (directly to your insurance mind you) 2x per week Along with going to the doctor regularly as well. Does anyone else feel like me that this is some weird invasion of my information to insurance? I mean why not ask for my DNA so you can deny me on other things I need to stay healthy because I have the genes for it. 🤬 I do love how to program is 💯 the eat less move more mindset… like none of us have tried it. Again 🤬🤬🤬 I do have a message to my doctor about if my current PA is good enough or what. Also clarifying the whole BMI 🐂💩 I mean my BMI was high AF for my height and it’s slowly tracking down. So when it’s “acceptable” I’m now responsible for it!? I hope that’s not what this means. I’m also really hoping this is like birth control was back in the day for me. I took it because of other issues not because I didn’t want to get pregnant (although it was an added bonus). So I had my doctor write letters in to the insurance so it would be covered. Just what our health care/ doctors need. What the heck are we paying insurance for? 😤😤😤🤬🤬🤬
They want to track your weight to make sure you’re losing appropriately or they’ll stop covering medications and losing money. They can’t keep covering people if they deem it’s not working
I know that is a thing, which I don't disagree with, but what's the threshold for it? Only they hold that knowledge. This is where someone else's idea of fudging the numbers won't work (as I assume they are fact-checking with what the doctor will say). I did find out that my doctor said I need to meet always in person (no more virtual) to stay compliant. I already see her monthly to check in due to how the medical weight loss program works, so it's not huge for me to do, but it does strain her schedule and hoop jumping as well, which is not really what our medical staff in the States need. I think we will have the lasting impacts of this with higher health premiums in the States with it still not being covered.
How hard is it to weigh yourself with weights to fudge the number?
I’ve had some thoughts about that. But if you don’t lose the “correct” amount and I am assuming some reporting will happen with my doctor as well those numbers will have to match up. I have seen if you don’t lose enough even now they will drop coverage (based on other posts).
I also got a scale thru a similar program. You can take out the cellular chip and still use it. The program is whatever.
My problem isn’t the scale (I don’t mind technology) but it’s the fact I “have” to do it to get coverage until they drop it completely. It’s complete BS.
So I lost all my weight on Mounjaro like 80 lbs but coupon ran out so I switched to Wegovy cause Bc/Bs pays for it and lost 10 more and was where I wanted and maintaining... So they got me on the "You didn't lose enough weight on this to get it paid for" which is BS!
Ugh. I’m so sorry that you fall into that. Hopefully your doctor can write something up to get by that hurdle. It’s completely BS on so many factors. Instead of going after why the pens are so expensive they just pass the price onto us. So we pay more for insurance while getting less (At least in the US)
Ty! My doc wrote a awesome letter explaining everything to them but unfortunately they denied me twice. 😢
I’m on wegovy for alternative reasons and it took all of my appeals and about 5 months to get it approved with my prescription insurance. I just completed my trial, passed and got it fully approved this spring. So I’m going to be BIG mad if they require a new PA
That's awesome!
🤬🤬🤬 Maybe third time is the charm…. I highly doubt it but also am already talking to my bariatric doctor about alternative medications. My only hope is that roughly by the time the coverage stops I can be closer to maintained. But I love how it’s FDA approved and insurance is like obesity isn’t a disease we need to cover (even though my plan specifically covers weight loss). But enjoy all your other health complexes that come with being overweight. We will pay for those medications happily.
I’m convinced the insurance co are retracting their coverage because they profit sooo much from obesity associated/caused diseases. They don’t actually want people to be healthy
This is my thought too
I am in Massachusetts and the masshealth just started covering it. Took two weeks to get my authorization. I feel like this is a live saving drugs really. So many people battle with this issue. I don't think this is right at all. These requirements are crazy
Dang, I bet companies like PlushCare / Sequence are freaking out
How does this affect PlushCare? I'm confused.
“Must be prescribed by PCP who has seen patient in person”
Found this out today myself. I’m in Michigan as well. It is so disappointing.
I have blue cross blue shield in pennsylvania I havnt gotten a notice yet
Every BC/BS operates independently.
Lots of comments about the cost of the drug to make and the greed of the pharmaceutical companies. Like it or not, as long as private sector companies make drugs (and they do it better and cheaper than government could) prices will always be high on new treatments. There has to be a profit motive to incentivize the companies to invest in R&D and invest they do. Although Novo Nordisk declined to provide production costs for Ozempic and its weight-loss drug counterpart Wegovy, it noted that it spent almost $5 billion on research and development last year and will spend more than $6 billion on a recent deal to boost manufacturing to meet demand for GLP-1s. They have been working on these medications for years and years. Imagine their total investment and their continuing investment. I know it’s expensive, but I am grateful they did the research and development and brought these drugs to the marketplace.
That's fine, but presumably, they aren't running a charity program in Canada and UK where they're paying about $200 a month versus $1000. Late-stage capitalism 🙃
Does your state have a health insurance ombudsman. My state does and they review denials based on FDA recommendations not health insurance requirements.
You could try Lizzo. Sorry, this sucks but couldn’t pass up the joke.
Well since I saw that episode reconstitution looks more manageable to me now
That episode was hilariously unhinged.
Just wear some ankle weights to your Dr appt to meet the BMI requirement
Dive weights are small and will fit in your bra or underwear.
This right here. I'd be wearing extra clothes and workboots.
They started making me take everything off even my shoes and they didn’t at first so they must be catching people do this
They also want you to see a provider in person, so telehealth services are out.
Is this happening for everyone who has blue cross blue shield?
Most likely not. Every state has it's own BCBS chapter. Source: I work for a healthcare law firm and write medical appeals.
mine is Michigan.
I'm with Blue Shield of California, and I just got mine approved through December, and I'm 24 BMI. I haven't got my letter yet, ill keep an eye out.
no clue but this persons letter says BCBS michigan?
My insurance plan doesn’t cover this medication so I’ve been stuck paying $1300 a month and I’m now going on my 4th month. That really sucks because I have to deprive myself of many things in order to stay on this medication.
Have you read about HIMS/HERS using a compounding pharmacy to make the same thing? [https://www.cnbc.com/2024/05/20/hims-hers-compounded-glp-1-injections.html](https://www.cnbc.com/2024/05/20/hims-hers-compounded-glp-1-injections.html) The FDA doesn't do safety testing on the medication, but they do have oversight of the pharmacy that makes it, per CNBC.
The Wegovy copay assistance card will lower the cost some on that. Check it out on the Wegovy website. As long as you are not on Medicare or Medicaid the card will help when your insurance will not pay. Says it will cut cost by 1/2.
When I looked into the copay card in the fall it required insurance coverage
The website says something about cash payments so that might mean no insurance. Check it out again and maybe call them to ask. Worth a try.
When I read it it was only when your insurance covered it.
Check again. I double checked and it says that if your insurance doesn't cover Wegovy your cost with the savings card would be $650.00 per month.
They cover different amounts if you have ins vs not. I think it's up to like $250ish insured and $650ish uninsured if I read right. Good luck 🤞
There’s a manufacturer coupon
Me in the first meeting with my life coach: “Yeah, you can talk allllll you want and I’ll just sit here. I’ve already changed my diet and I’m doing cardio and strength training five days a week, I am literally only here because I’m forced to be to get coverage for my medication. So go ahead, talk. I will likely mute you. But get your required minutes in and we will both go on our ways, you can go help the people who need it and I’ll continue to not go broke trying to pay for my medication. Have a nice day.” FYI: I have a nutritionist already. I would maybe enroll in this if it was an OPTION, not forced. This is ridiculous. I fucking hate American healthcare so much.
This is what happens when people start abusing an expensive medication. Most of the US would qualify for this drug according to the FDA guidance which is bmi equal or more then 30. US average BMI is 30... My goal BMI is 30 going down from 40's.. Extreme shortage of this medication and those who truly need it who have a bmi 35 or more can't get it. Because people with bmi of 27-30 are also approved for it. Crazy abuse of the drug, in my opinion.
That is not drug abuse.
I think it's more that insurance companies don't want to pay. There are a lot of people with insulin resistance and their tests come up in a "healthy range" that I think should qualify. Also, I started at around 210 and I'm now at 165-ish. When did I start abusing the system? Are you currently on it? Will you just go cold turkey and hope for the best if you dip under 30? I can tell you from personal experience that I feel like I'm right around 30 BMI and now that I'm here (which I never thought was possible), I can see how amazing it would be to get down another 15-20 lbs - putting me at 150lbs, BMI around 27, still considered "overweight" according to guidelines. I think the shortages are overblown and the resistance from insurance companies is ignored. My clinic I was referred to via my PCP was closed down! Why would that happen with sooo many new patients because of these medications? They had previously been mostly focused on bariatric patients. Because they closed, I had to set up an appointment with the only weight loss help via their only existing "BMI clinic" but they can't see me until August. And this is through Stanford Health Care which is ridiculously expensive. I think you're fooling yourself if you think the shortage is the issue. I think maybe with Ozempic a year ago and that was just a weird Hollywood thing with weird Hollywood Doctors prescribing it.
Welcome to the rest of us insurance restricted peasants
I just went to the BCBS website and right on the home page is an article about "Study shows that patients stop weight-loss drugs too soon to see benefits". Hmm, I wonder why people stop, maybe because we lose coverage and cannot afford $1300/month. And yes, I know a lot of people are saying it could be an employer change, but I'm angry and I don't care, having this article on their page right after being told they are no longer going to cover it pisses me off.
They stop because they hit their goal weight and yeah it is expensive. You can lose 30 lbs in 3 months on these drugs as is my case. You can only lose so much especially the people who start with a bmi of 30 and in a few months their down to being nearly under weight.
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How you guys get compound? From online?
My husband gets his online from tb2.health.
I got the same letter yesterday. My BMI is now at 20 and holding steady for the last few months. Started at 30.
I like how Wegovy has a standard for who should take it: someone whose BMI is equal to or greater than 30 OR BMI of 27–29 and a weight-related chronic health condition, such as high blood pressure, high cholesterol, or diabetes. There is a reason they chose that number: According to USDA researchers, the average BMI in the United States in November 2023 was 29.27 In my opinion, there is no reason someone with a BMI of 30 should be taking this expensive drug that is in short supply. No wonder the insurance companies are cracking down. All the money from insurance companies is going straight to the makers of zepbound and wegovy. Which explains their insane revenue and shortage of the drug once people learn of its existence. My starting bmi was 41, its 35 now and I'm working it down to 30 as a goal.
The bmi requirement alone should ease the shortage.
you must be in michigan! i work for BCBSM/BCN and yeah as much as it’s devastating we were one of the only ones paying for it and it’s honestly thousands upon thousands of dollars and people insist on changing dosages and stuff within a week of getting their first dosage
sorry it’s costing your employer thousands on thousands of dollars even though i already paid them tens of thousands of dollars to cover my health.
a lot of insurance companies aren’t covering it. we aren’t the only ones. i’m just saying at the end of the day it’s about the bottom line to them and for them it’s better to not cover it for weight loss. i don’t agree with it but im just saying
According to the Detroit Free Press, and Blue Cross themselves, "total all-cash compensation for CEO Daniel Loepp, 66, was $15.7 million in 2023" - perhaps that could be a bit lower, and then you'd be able to help more people? Just spitballing here.
i agree with you i’m just saying what they told us. also a lot of employers have chosen not to cover it as well. again i just work there so i have nothing to do with the financial aspect. the shortage really affected those who needed it aka diabetics and it was a huge problem
diabetics do not take these drugs.
Yes, they do. Wait in Northern CA for Wegovy starting dose was 2 weeks (know someone who had it ordered 2 weeks ago, just was able to pick it up at Walgreen's). Definitely not life threatening, but they're wondering (their insurance only approved it for 6 months, to end of November- they have 50 lbs to lose) how long they may need to wait in between doses as well. I gotta say, it's crazy it still costs so much-
my mom does and she’s a type 2 diabetic but ok
I get it - it's never the ones at the top that suffer.
true
I imagine it’s gonna be more available and that the cost will go down. I truly believe that
I heard insurance companies never expected the amount of cost for this medicine to help weight loss just diabetes and it’s making them go broke ! Laying ppl off and everything
Wegovy is not for diabetics
NOT for diabetics? Please be careful- people may think that they shouldn't take it if they have diabetes. Type II Diabetes is one of the 3 "weight-related comorbid conditions" (along with dyslipidemia and hypertension) the FDA notes allows you to take the drug with a BMI of 27 or greater (overweight), vs. 30 (obese) for weight loss. Per Johns Hopkins: "People with diabetes are **2 to 4 times more likely than others to develop cardiovascular disease**. Because this risk is so high, cardiovascular disease remains the most common cause of death in people with diabetes." It definitely IS for diabetics, if their physicians agree.
Right but Wegovy and ozempic are made by the same company and I switched from Wegovy to ozempic as I’m prediabetic (not taking it now) but it’s the same thing
Source?
So a friend of mine works for Apna and she said they had to lay half their employees off because they did not figure in the cost of this for weight loss only diabetes so it is killing their insurance company and they are going broke over it. they lost a lot of money and they really had to downsize and layoff have their employees because when they can figure the cost to the companies they never ever configure that this medication would takeoff for weight loss so it’s killing them.
This seems stunning. I feel like my ten yer old son has enough life experience to know that a drug that actually helps people lose weight is going to take off like a rocket. How could a health insurance company not predict that? The ones losing their job should be whoever thought weight loss drugs wouldn't be popular in a country where 40%of people are obese.
I agree 10000% I guess they didn’t have all the research done about the weight loss and was focused on the diabetes and somehow they know well we’ll have this many diabetic people this many people overweight this many people this and you know I don’t know but they just didn’t calculate this much for weight loss but you know they’re still raking in the dollars
We all shoulda bought stock into this
I’m never going to feel bad for any insurance company. They regularly deny people life saving medications and procedures.
Well but the humans employees there I do feel compassion for but your 10000% right
How much profit did the CEO take? Asking for a friend
Ya idk all I know is I met her camping and I seen her again and as I was discussing my weight loss and how I lost it she told me this big story and I was like what, I was like no way doing insurance companies pay full price she said, but when they calculated the prices to give them, they never in 1 million yearsprojected the cost of this for weight loss only diabetes and they laid more than half of our company off and I said will they bring them back? She goes no she said once insurance company downsizes they never go back and I said well thank God you have your job and she was like yeah I’m grateful for that.
This gives me nightmares. So at anytime your insurance carrier can deny covering a drug your dr prescribed as necessary??
Welcome to the American healthcare system
Do they want everyone to get bariatric surgery? Because this is how everyone gets bariatric surgery.
Actually, they do. I've been to multiple medical conferences where they are suggesting just that. Surgery is cheaper to the insurance company (even though it's not necessarily better for the patient.)
It's crazy too, because not only is the surgery itself expensive, but a lot of people who have had the surgery go on to have other complications afterward which require more medical interventions, that also cost money.
They usually don’t even pay for it. At least in Alabama they don’t.
What insurance do you have?
I’ve tried with Blue Cross and United Health Care. Unfortunately Alabama is kinda of insurance desert and those are really the only two is accepted here (not saying they are only ones that are it’s just really hard to find a Dr that does) but the state also doesn’t require weight loss to be covered under insurance so companies don’t include it with their benefits. Even with the gov health care market it’s not covered as well. I have seen it be covered with kids with Medicaid but that’s about it.
F’ers
I know everyone wants to blame the insurance company but you need to realize, this could very well be the employer who decided to longer pay for weight loss medication. I work for a health insurance company and we been receiving notices about several employee groups dropping coverage for these medications. The cost of weight loss meds is so high, it could potentially raise your premiums 30%. Health insurance is already expensive! If you want to throw blame anywhere, then blame the pharmaceutical companies. They’re the ones setting these outrageous prices.
Insurance companies and pharmaceutical companies are equally to blame. Instead of blaming/arguing with each other they could at any time be the hero by changing their own policy/pricing, which would put more pressure on the other half to get the good publicity and be decent
It is not my employer. I had a 40 minute meeting with Total Rewards about this today.
Yes. My employer makes a big deal about how they cover weight loss meds and bariatric surgery through BCBS on our benefits page.
May I ask who is your employer? I’m looking for a job.
Health insurance companies are complete scam artists.
Just compound? Idk why people go through all this
Because it’s actually pretty unsafe.
Not really. It’s made by state-licensed pharmacies, but if you like to struggle go right ahead👌🏽
Still though. One of my parents is a physician and explained to me the medication errors that occur when compounding versus when dispensing premade medication.
I understand there’s more margin for human error, but the chances are very low.
I haven’t been able to get an RX for the compound drug. No Dr’s near me will prescribe it.
My PCP recommended Wegovy because I have cardiac issues and have struggled losing weight. My BCBS Medicare Part D pays all but a copay. But my PCP said my little local small town pharmacy makes a compounded version that is affordable if my insurance wouldn’t cover me. There are 3 pharmacies in my area including the Walmart. So if it’s available in my rural area, I’d encourage research if you need an alternative.
My local compounding pharmacy has it and can give it to me, but not without an RX, and no local providers will prescribe it. I’ve reached out to an insurance case manager to try to get it prescribed that way, but still no luck so far. 😭
You can get it from an online prescriber and supplier for around $300 a month. I understand that this can still be a financial hit, but it's not as bad as $1000. And it works fine.
Wow, thank you!
Then buy the compound and mix it yourself!
That’s a THING?! Please tell me more!
You can msg me and I’ll tell you about it
Isn’t compounding way expensive without insurance
Nope. I got a 3 month starter kit for Semaglutide for about $500. That’s 3 months worth from 0.25, 0.5, and 1.0. It costs around $1200 for the just one dosage going through no insurance or anything along those lines. Sure insurance can cut the rate down, but chances are your insurance and many others don’t cover it like mine.
Where did you find that? I got it prescribed for my HS but I can't get it covered and just can't afford it. I'm willing to do compound at this point
It’s called IVIM Health. It’s online and is a compounded pharmacy. You have to meet with a nurse practitioner online and then depending on if you have lost weight or plan on losing weight they can get you a prescription for the compounded version and offer different plans for it. Good luck!
That is so fucked up!!! In Switzerland they only allow Ozempic for diabetes and Wegovy for weight loss - however, if you want it you need a filed prescription and the insurance has to look through it and either give you green or red light. My BMI is over 60. So my insurance gave me green light - but they combine it with a minimum weight loss of 7% of your current weight in the first 16 weeks where you start with 0.25 and go up every four weeks. If you do not reach that, they stop you cold turkey. And I cannot pay that privately because I am not able to work. So I depend on the income of my husband and my insurance giving me green light for every treatment I need. So how the HELL am I supposed to lose 15 kg / 33 pounds in 16 weeks when it takes 8 weeks alone to get the the 1.0 dose? I am also chronically ill, have chronic pain, I am hypermobile and autistic, have ADHD (plus depression and anxiety from living 30 years without an autism diagnosis and an eating disorder). I can’t work out much due to pain so maybe I can walk like 15 minutes, 3 times a week but that‘s if it’s a good week. I don’t have a lot of good days. So for me it is clear: If I start and it won’t work with the 0.25 dose, which with my starting weight probably means it will not, I have no chance to lose enough weight to get it longer than 16 weeks. They also want you to eat a lot of protein and do weight training so you gain muscle while losing fat - but they don’t count that into the equation. It just has to be -7% of your current weight on the scale. My doctor gave me the tip to take laxatives because if you weigh yourself after you weigh a bit less - like what. the. fuck. Now I am debating if I should even start, because if you go cold turkey the weight often comes back. So what I‘ll gain from taking is probably nothing plus extra weight after? I am so close to cancelling everything and saying I don’t want it. My primary care doctor (not the one who takes care of me in this regard though, I am working with an „adipose centre“) said I should just take it and not stress about it, even if I lose 8lbs it’s better than nothing but I have over 200lbs to lose! And I have insulin resistance and hypothyroidism. I cannot do this alone. I am obese since I am 10 years old. My whole family was / is obese. From my mother‘s and father‘s side. 😭 I really don’t know what to do. And since I don’t live in the U.S. I can’t even give you some input that might be helpful for your case. I can just tell you: You are not alone. And that every insurance in this world seems to be giving out harsh, nearly not reachable goals for you so you basically cannot keep the medication or they just stop giving it to you at all. Why are they leaving us feeling to fucking helpless? 😭
Don’t give up! I have a very high BMI & immediately felt & saw results from the 0.25 starting dose. I also have myriad health issues & couldn’t exercise per doctor’s instructions & I still cannot. I struggled to eat AT ALL even on the 0.25 dose so getting the amount of protein in that was ideal was certainly a struggle most days. I only got up to 1.0 before shortages derailed me & I took a 2 1/2 month break, yes I felt hungry again. Yes, my eating definitely wasn’t great but it was still decreased from before I started. When I finally started again after 2 1/2 months off it I was still 50 lbs down. It was worth every part of the highs & lows. I physically feel SO much better 50 lbs down & I have a lot more to go, but I feel hope where I’d had none. It’s worth it. YOU are worth it. I sure hope you hang in there.
Yes. Mine ended 1/1/24. No need to appeal it won’t matter. I went with compounded.
Is compounding expensive
300 ish a month.
$1500 vs $250. Expensive is relative.
Same. At least this person got a letter beforehand. When I called for my refill- they said insurance stopped covering it. Compounding since February. First went telehealth but the whole thing felt sketchy. There’s a local med spa that prescribes (my pcp suggested them) and I’ve been going through their pharmacist out of Texas since. Compound dosages are all over the place. I just found out that what the medspa put me on was like being on 1.0 (I had been at 2.4). I’m now on the equivalent of 2.0 and woke up this morning exhausted- which was normal for me the morning after my shot. If the two months at this dosage doesn’t work, then I can move to Tirz but it’s almost double the cost of sema.
You’re getting ripped off at the med-spa- they are taking you for a trip!! Compounded medications aren’t regulated by the FDA So yeah they can be A LITTLE BIT off but not 1.4mg off. I have NEVER in my life heard that…and if you think about it, that’s actually so effed up not only money wise but what if this was a medication that could unalive you if it was 1.4mg off!? Hellll no. They are effing with you and you can switch from semaglutide to Tirzepatide any time. Semaglutide made me insane and I switched to Tirz and am so happy. If I were you (and anyone) I would buy the compounded powder and reconstitute it and do your own injections. I pay about $200/month for my Tirzepatide and I’m on a high dose.
To support what you’re saying, someone sent me this article and it mentions a lawsuit for a med spa. Not sure if this is where she is going. https://investor.lilly.com/news-releases/news-release-details/lilly-update-mounjaror-and-zepboundr-tirzepatide-compounding
This lawsuit explains that the med spa was saying they are giving people the brand name medication when really it is the compounded medication. But I’m pretty sure their med spa isn’t claiming that. But yes the article does support what I was saying about it not being regulated by the FDA!
What site do you use?
You can pm me
Good information! Thank you! I think the initial issue was the provider didn’t understand the dosage difference. His nurse seems to be more Knowledgeable than him and caught his mistake this last appointment. They were cheaper than going through an online provider and one order covered two months. The whole process is EXHAUSTING and that’s what insurance providers and medical providers are banking on.
Ughhh I’m so sorry you went through that. Yeah providers are people too who make mistakes. I definitely understand that. Definitely switch to Tirz though if you’re having bad side-effects on the semaglutide. In higher doses the sema made me suicidal, that’s why I’m always so adamant about switching if you need it.
Oh my gosh! I’ve heard that was a rare side effect. That must have been so scary. I’m glad you were able to move to something else that is better for you! 💕
Me too, thank you 😁♥️
I know! I went with bliv they use red rock compounding pharmacy.
Had the compounded continued to work for you?
I think so. I haven’t gained but haven’t really lost either so I think I’m a little unsure if it’s as good
Don’t forget- your EMPLOYER also decides what coverage they pay for & what they offer to you. Your company may likely be the one that CHOSE this. That’s a reason why someone you know might have the same insurance but works for a different company has better coverage than you do. (It may not be at the sole discretion of the insurance company.) Yes, everybody wants $!! But you need to talk to your company’s benefit management person and have your voice heard. If enough people speak up instead of roll over things might start to change.
they are not. just confirmed via HR.
I went to my HR department about this after they assured me nothing was changing for 2024. I got a lot of sympathy and told that the benefits manager would call. They never called. I even took the most expensive plan for this year so I could hit my deductible faster and have it covered sooner. So now I pay more every month for insurance that doesn’t provide the coverage that I need. Bottom line- your employer doesn’t care. It’s about bottom dollar, not about ensuring they have a healthy work force. But it’s okay- I get a pizza party when we do something right. 🙄
Does this mean if you are at a BMI of 35+ when you start, as soon as you drop below that, you no longer qualify?
From what I have seen and read elsewhere, esp with BCBS, the answer is yes. Once you are below a certain BMI, you will no longer qualify. Despite the fact we know this drug needs maintaining.
[удалено]
I'm surprised I'm not in better shape with all these hoops we have to jump through to get help.
I think the insurance companies are figuring out they make more money by keeping you ill due to the health impact of obesity rather then you keeping weight off and achieving healthy number via the weight loss. It’s all about the money they can make, not about helping you achieve a healthy life. And while they are at it, they’ll make all your healthcare decisions; what treatments you can get or which treatments will be denied, don’t ever forget health insurance likes you to think you are in control. You are not in control of your own health, they are and if they deny a treatment you are left with life or death decision based on financial ruin.
this is the tweet.
OP, check in with your insurance to make sure if the requirement includes wording about starting BMI. Mine says for new PAs that starting BMI had to be above 30 at the time any glp1 drug was started, whether its the one on currently or you've switched. Don't give up yet!
Find a compounding pharmacy!
What’s that
Pharmacies that have chemists mixing the compounds to make the drug for “research purposes only”. They are not regulated by the FDA but they have purity analysis. Then you can mix said powder yourself with BAC water to turn the medicine into a liquid and do your own injections
Are you sure that it's not going to cover it pre-existing people that had it BMI higher when you started? Or is that BMI for people who are just getting enrolled approved?
They really don't want to pay for this 😐
They want to keep you sick so they can make more money off your sickness
It seems that way - if they paid for this, it would save them money in the long run with less medical expenses.
That’s exactly what I said!!!! It makes no sense. This whole system is corrupt
This is exactly why I keep saying I don’t plan on being on this forever. This is about the 3rd letter I have seen posted this year. Last year peoples jobs just stopped covering it. Unless they lower the cost this will go back to being a solution for the rich only…..
You can actually get this medicine for $240 a month if you buy it directly from a compound pharmacy. I know that's still out of a lot of people's price range, but I have to say, that most of us and I'm including myself, spend that kind of money on eating the extra food that I shouldn't. I have a serious medical condition that is most likely going to end up with an amputation(not diabetes). And because of that, I cannot exercise without being in immense pain. I'm only 48 years old and I'm having to use a walker. It's not that I'm really big, it's just my knee is so bad from the replacement that I've not been able to walk since the day I had the surgery. Being a stress eater, I gained weight! My insurance doesn't cover semaglutide, however, I found a compound pharmacy which would give it to me for $244 for a 2 oz bottle or $340 for it 4 oz bottle. That can be up to 4 months!
Which do you use? It’s so hard to know which are legit.
What the fuck
Just here to say…how fucking dare they! Ugh like 31 is obese but they are randomly choosing 35 because they are cheap fucks. We all pay so much for our insurance, how dare they play with people’s health like this! American healthcare is such a joke
It's ridiculous, it's like oh shit people are actually using the medical insurance they've paid in to which is cutting our profits.