I just looked at a report and ozempic accounted for about ten percent of all drug PA request for one plan I manage. 23k request. Next closest was 8k for suboxone
Look I try to make easier but I can only word the way the plan sets forth the guidelines. I don’t ePA questions and my job is to make it so it auto approves that’s my goal. Now sometimes the plan makes really stupid requirements but that’s someone else’s job.
Zero clue prolly when the first glp hits generic. Which is prolly a long time away. I guess victoza and Betta might be close but don’t think those work as well for weight loss. My company essentially eliminated bonuses this year bc of all the money spent covering these drugs (prolly gave the ceo out money but that’s what they are telling us) but there is a rec drug that was like 5k synagis that had a lot of hoops to jump through. A new drug came out that’s like 1k and basically covered by insurance no questions asked bc rsv hospitalization are so expensive. So seemed preventive care
Diabetic. I was surprised I got to stay on it because after like 4 months on it my A12 went from 6.5 to 5.8. Of course I also lost like 20 lbs. in that span.
Yeah insurance will start covering it when they're incentivized to give a shit about 30 year outcomes in other words fuck them and America
On the surface, getting physically ill from eating seems worse than being hungry from not eating. But food is not one of my many addictions, i’m not casting stones. Just thinking out loud.
I got checked out by my doc when I told him how my GERS had gotten bad again. My medicine was the lowest strength, he bumped me up to the next highest dosage, told me to take it daily for like two weeks then start scaling back again. I only take like once every three days now and rarely have anything more than minor problems that just resemble regular ole heartburn.
You still have type 2 diabetes. It's just really well controlled, so you should be able to stay on it. You met diagnostic criteria
So does Ozempic have some kind of ingredient that helps control A1C and also suppresses appetite, etc? Or is it mostly the fact it forces dietary changes which then helps the diabetic aspect? With mine at 5.8, Im trying to finally start taking it seriously by dieting and working out more. Just curious how “easy” it is to manage naturally once it gets to this range. Maybe a dumb question.
I’ve been skinny or normal weight my whole life so I definitely was in camp “just eat less, durrr” pre-med school, but there are clearly differences in ghrelin and leptin levels that are a huge driver of hunger/satiation. I’ve had a couple of lifelong morbid obese guys who literally say that being on ozempic is the first time they’ve ever understood what “full” felt like.
My favorite is when insurance companies are like "you have to try Byetta first" and I'm like ok here is your Byetta come back in a month when you feel like garbage.
My favorite is when insurances tell patients their ozempic will be covered with a prior auth by their doctor, then after getting their PA declined they get mad at their doctor instead of their insurance company that lied to them about their coverage in the first place. Biiiiig fan
It’s stupid. The requirements that they have out in those drugs is crazy now. It rivals biologics now for submission for documents and stuff makes my job harder and I’m sure everyone else’s too
I historically hang around in the bmi upper 20s range aka "hogmollie." Was far less in my 20s, but most of childhood was in the gbr range. Thankfully my bmi ain't a complete runaway train because lord I could eat pretty much any time, any amount. And "just don't open the fridge at night" yeah it's like a demon possesses me. So in med school when we were learning about appetite/satiety neurohormonal regulation and how is primed early AF, even in utero, it honestly felt kinda liberating. I wouldn't know how to really look at a bmi of 22 so I'm actually pretty happy with my weight and health such as it is, so prolly will never go on glp1 so long as I hang out at historical average. But it's really easy for me to understand why these meds help so many people.
this is by far the biggest flaw in employer insurance as we move towards functional cures for diseases that require one-time (gene therapy / editing) or chronic treatment for long-term outcomes.
i had a 7000 calorie day yesterday. at no point did i feel full or satiated, only drawn to more food. that's not everyday but it's far, far too often.
mechanistically, GLP-1s are really fascinating. and still so much to understand how they work. but they continue to amaze me.
I get that this isn't your job, but you understand that's an extremely difficult task for a patient to do with a medication that might be life saving? It's so fucking difficult to get a straight answer from insurance companies and pharmacists seemingly are understaffed everywhere and have such a little amount of time to answer questions without showing up in person bugging them. I'm more familiar with the system than I was prior to having a kid and getting married, but it's still an insane headache why suddenly I am unable to get a 90 day prescription filled at any pharmacy now for basic medications after I moved, let alone figure out wether insurance will really cover the cost of a very new medication.
I work for an insurance company. It’s bullshit the hoops they have to jump through. But a patient can do like 90 percent of the work by just calling. They can tell you the preferred drugs, if it requires a PA etc. I don’t like insurance companies but retail was sucking the life from me and now I work 9-5 job. If anyone ever has insurance issues feel free to reach out. I’ve helped a couple people navigate PA approvals
My assumption, which as happened in the past, is that I basically have to get Cigna to be the ones to fill it through their own remote pharmacy and mail it to me. For my blood pressure medication I'm taking amlodipine which is I think basically what everyone is prescribed so there's no reason why that one alone wouldn't be the preferred drug.
No clue how Cigna works but that drug is dirt ass cheap and is likely preferred. But usually they give discounts for maintenance medications if you use their pharmacy. Some prolly mandate maintenance medications being used with their mail order but I’m not on that side of things. If you call or go to your benefits they usually will outline where you can get stuff. Sometimes they limit it to 3 fills then use mail order. Sometimes it’s free of mail order and a 20 percent copay for a pharmacy to dispense. All of that is on the EoB but they do a terrible job with explaining that stuff
For any wealthy posters who don't mind paying, tirzepatide (Mounjaro/Zepbound) looks to be head to head better for weight loss than semaglutide (ozempic/rybelsus).
Yes, I understand that. It's a terrible, awful system. I'm a healthcare consumer, too, I deal with all the same shit. I totally sympathize. But it's ridiculous when patients expect me to call their insurance for them, know immediately off hand which pharmacies carry it at any moment in time, etc. Most patients get it. Many need their expectations adjusted.
i generally feel like the only purpose to life is consuming things. eat too much, drink too much (not alcohol), vape too much. it was an absolute miracle i was able to stop biting my fingernails.
Also a favorite of mine. -yes, yes well of course I know your insurance plan's formulary coverage. Not only the entire formulary, but the exact formulary for your specific plan and deductible! Those fuckers from your insurance company won't even tell me the preferred medication options when they deny my prescription! They're like "refer to our formulary brochure for covered options". Motherfucker you've never given me your formulary options in the first place! Just tell me wtf you want me to send instead and I'll fucking do it!!!! I will literally help you and the patient save money, just tell me what to send instead that's coveredddddddddd
A lot of people have no clue how to pick up a phone. It’s pretty unreasonable to have doctors track every single insurance. Most will know what their states Medicaid overs, a few Medicare plans and maybe the number one commercial plans. Medicaid and Medicare are lettty standard. Commercial plans are the wild Wild West
I can understand that being asked for the hundredth time to call their insurance is annoying but that's the exact kind of question I would ask too if I had no idea how any of this worked. I'm not sure what kind of resources your practice offers to help patients so they aren't bugging the providers. My company makes intake software that practices use and we quite literally have found that patients often don't get their prescriptions filled for just basic shit because they literally have no idea how to properly inquire about their prescription, and when the office offered even a modest amount of help the success rate was very high.
we are working on this or atleast my team is. We either try to to put the preferred drugs into the questions or provide the pdl link.
Yeah that's why I'm just like "call your insurance provider tell them these words, write down what they tell you and send me a mychart message of what they say and where to send it." It *still* only works some of the time. Then I get all the patient telephone encounters of "wegovy PA was denied, please advise" and I'm like "idk reform society and get a flu shot"
Yeah I include some basic stuff on what a formulary is, how to find out what's covered, and such. But the onus to navigate one's benefits is on them. That's how our society has structured it, and it blows. But primary care offices are already over stretched to provide the care they can, and so it cannot/should not be up to the Dr office to try to correct all of society's shit.
Yeah but now it’s “submission of medical records document t/f or bydurean, submission of medical records showing diagnosis of type 2 diabetes, submission of medical records documenting risk factors for ascvd. This is all coming from the client side we just manage whatever that tell us. Most of what i work on is state Medicaid and they really don’t want to pay for it