FatAnon: Where Wegovy One, Wegovy All

What happens if they can’t get insurance to cover it? I see here it’s much cheaper to do a 6 or 12 month plan but it also reads like you can’t cancel early.

Do you not get charged until it’s confirmed insurance covers it?

 

You should know before you sign up if your insurance will cover it. All of that is available upfront.

 

I need PA. I guess what I wasn’t sure of is if this WW clinic might have some more pull with getting it approved.

 

My insurance required a PA for the T2Dm versions, and would not cover the weight loss versions for any reason. I'm guessing it might be similar for you. In that case it's all going to come down to blood work. If you aren't diabetic, or pre-diabetic, it might be an uphill battle. Your best bet is to look on your insurers website to price the drug and get a sense of what they will/won't cover.

 

The weight loss and blood sugar levels I'd read about but hasn't heard anything about cravings. That's good to know. Are side effects really stronger/worse with Tirzepitide?

 

You can look at your Rx formulary and see if wegovy is covered for weight loss with a PA, and how much you'll pay. You should be able to find the PA form and see what they require to approve it. If it's covered for weight loss with a PA, WW will be able to do the work to get that PA.

 

I haven’t experienced any side effects on either.

 

Got it. Yeah I’m pre-diabetic (was 0.1 into that range, so barely as of last year) and the insurance company didn’t approve it so I doubt this would be any different.

I’ll double check the PA form. My insurance uses CVS Caremark and anytime I’ve tried to find coverage or a formulary it’s a complete debacle.

 

Perusing Reddit, it seems like at least some insurances cover Zepbound for Obstructive sleep apnea, I've never had a test for that but I'm pretty sure I have it. Unfortunately, the insurance companies make it incredibly difficult to get a straight answer on this.

 

I had BCBS when I got my PA, Also used caremark. I'm surprised they couldn't get it approved if you're prediabetic.

 

Yeah, I’m tempted to try again. I don’t know what my Dr even sent to them, and after it got denied they weren’t really into helping me appeal it or anything so I just moved on.

 

From what I was told, the PA for wegovy has a BMI benchmark, and requires you to have tried another diet/weight loss program for 6 months. I had used weight watchers or noom in the past so I qualified, and they never asked for proof before they sent off the PA

 

Interesting. Yeah I was never asked any questions or anything from the insurance company. It was all through the Dr. Tempted to just try the WW thing for a month and see what happens.

 

I found some good info on Reddit about the PA approvals for wegovy when I was googling it a while back but didn't save the post. Someone described pretty well how to get it approved or how to appeal, wish I had it saved.

 

If you find this I'd be interested

 

Are yall saying "PA" short for physicians assistant? Or prior authorization, or what?

 

Prior Auth

 

So did you fill anything out or did the WW clinic people handle it.

 

Freakonomics had a great podcast on GLP-1s, the insurance industry response, and so forth. Great listen.

 

Maybe try a link from your browser?

 

Just a shot in the dark as to which episode is referenced above

 

They do everything. You fill out a questionairre and get labs done. They take that info and do whatever magic they do behind the scenes to get the PA.

 

Cool. Will look into it more tomorrow but this might be worth a shot (no pun)

 

YMMV, but for me it was a very easy process. They offer a nutritionist as part of the program, I've taken advantage of that but otherwise don't follow a weight watchers plan.

 

Let me know how it goes. I called my pharmacy today and they said they don't think they'll have an issues for the foreseeable future with compounds but if I can get Zepbound bc of sleep apnea, I'll just do that.

 

Sorry… can’t link it for some reason (I.e. user error). Freakonomics episode is titled “Is Ozempic as Magical as it Sounds?” In a general sense the episode unequivocally says yes, GLP-1s and similar drugs magical for all manner of things, and also provides data and reasons why insurers generally don’t want to cover it in non-diabetic contexts despite it having the potential to drastically lower long term healthcare expenditures for large segments of the population.

Search for it on your favorite podcast platform and you should be able to find it.

 

Yep this is the one - thanks.

 

Just took my first dose - only $35 for a month of the zep pen

 

I’ve heard people say they puked or shit their brains out, is that something that y’all dealt with?

 

I have no experience but the zep pen has the 2 hormones and one is for nausea control.

Had a diabetic assistant that went on ozempic a couple years ago and she puked after every meal. I don’t think she changed how she ate at all though. Sounds like that’s a big problem.

 

Where from?

 

Went back looking at this further today and found where it notes the $145 a month does not include medication

Require me to pay $45 to find out how much the medication is........

 

Walgreens + insurance

 

You have to pay attention to what you eat and how much, and you can probably manage those side effects. If you don't, you're in for a bad time.

 

I’ve heard that overeating is strongly inadvisable, and I guess high fat food and high sugar food as well?

 

Yeah. It should be pretty hard to overeat if you have small portions and listen to your body. I noticed that pretty quickly, I didn't lose my appetite at all and haven't had any nausea yet on wegovy but I did meet with a nutritionist and get some info on what I should be trying to eat and I just want less.

 

my understanding is that there is more to the mechanism than just calories in / calories out, yes.

from what i've read the drugs do do something with insulin resistance / insulin sensitivity which makes your body less likely to store excess calories as body fat.

 

Yes on ozempic. Think it was a couple of things for me. It started about three months in when I increased doses to the highest and stopped when I dialed it back closer to the previous dose. Also determined there are certain foods/restaurants I can’t eat without getting sick. Seems I’ve got it under control now.

 

Sign me up. Did my annual physical and he suggested a compounding pharmacy and wrote me a prescription for Semaglutide at the lowest level. Will start it shortly.

 

Had an appointment with my new doc. She’s switching me from Mounjaro to Zepbound and bumping me up to the 12.5mg dose.

I’m down 53 pounds since 7/26.

 

Why'd she change the name of the medication, those are both the same thing?

 

I guess she couldn’t do Mounjaro because I’m not diabetic.

 

It’s going to be nice paying $0 per month instead of $550.

 

Got my script refilled and dosage upped for compound semiglutide. Wondering if I should start rationing my dosage?

Assume it's going to be next after tirzepatide

 

Go to Colombia and buy all of the name brand Ozempic you want for ~$150 per one month supply.

 

How illegal is it to bring this stuff stateside assuming you dont have prescription?

 

Getting a prescription is easy. Getting it cleared by insurance is the big hurdle

 

If you have a prescription it is legal, I think

 

So has anybody in here been on one of these, lost the weight they needed to, then tapered themselves off? Curious to hear your experience if so.

 

I think he’s asking what are the repercussions if you brought it back and someone caught it (like TSA or something).