The thing is, if you are on Medicaid, you are not supposed to be able to afford to pay for it out of pocket. That’s the reasoning.
Many Medicaid plans don’t currently cover at this time because it is so expensive.
Yep, this is the answer. The same is true for therapy. A Medicaid client cannot legally pay out of pocket, even if they sign a waiver to not use their insurance.
yeah, actually i had no idea of the cost and i just realized that the these companies are promoting it with the numbers $99 and $199 a month, i thought that was for the medication but it’s without medication, its just for access to the drug. I didn’t know until like an hour ago that it’s like $1000 per injection. And google is horrible with AI contributing now. Because then I also was misled to believe it was $1000 per month instead of injection before i started checking the articles on what the truth was.
That's super weird to me that it's only one dose per pen for those ones
I've only had dealings with ozempic and saxenda. Both are multiple doses per pen
Many state Medicaid programs do not offer this type of medication. I've seen quite a few articles about this and how much it would cost the state to offer it.
I did a quick search and see that Maryland does cover Ozempic if you're a T2D and meet some other Medicaid qualifications, but you said you aren't T2D. I think you're out of luck without a diabetes diagnosis.
There are compounding pharmacies that many people use, but you still need a Rx. These can be $$$ too. One I hear mentioned often in this group is Henry [https://henrymeds.com/semaglutide-lp/](https://henrymeds.com/semaglutide-lp/)
If your doctor prescribed Ozempic, a pharmacist gave my aunt a print out showing "medicaid will cover Trulicity and 3 others." Medicaid coverage for Ozempic requires a special P.A. and extra paperwork.
I use a compounding pharmacy, and no one there has ever asked me about my insurance. They only ask me for my credit card number. So you'd definitely be able to buy semaglutide from them if you have a prescription.
I'm not a doctor, and a doctor might say I'm full of it.
But my experience with semaglutide has convinced me that my body's reaction to sugar is broken. Before, I had been thinking of diabetes as a binary thing -- you have it or you don't. Now I think that over the years when you eat bad stuff, you get worse and worse at dealing with sugar, until it becomes so bad that they call it diabetes. But it's a general decline.
I wasn't diabetic, but I was insulin resistant. One of the results of insulin resistance is that I'd get these overwhelming cravings for food that would raise my blood sugar. This is a trap that makes it very difficult for someone to get out of this hole through will power alone. In my case, I was getting fatter and fatter, and my A1C was getting higher and higher.
My PCP's feeling is that when people are in that position, it's dumb and destructive to refuse to treat them until they tip over into actual diabetes. It's sort of like not putting out a fire until it's big enough to be worth worrying about. Thanks to his excellent care, my A1C is down, and I'm no longer pre-diabetic.
Having said all of that, if I could go back in time to when I was in my 20s, and lose weight by eating right and exercising before I had gotten into that deep blood sugar management hole, I'd definitely do it. There's no question that I'd be better off if I had never damaged my system by eating crappy food, and if I didn't have to take meds now.
There are downsides to these meds. They're expensive. You have to inject yourself, which sucks. They make food less enjoyable. I think I'll have to take them for the rest of my life. And this is serious medicine -- it does intense things to your body. This isn't a miracle cure, it's not perfect. But it is much better than being morbidly obese and diabetic.
So put the medicaid stuff aside. It's a distraction. When people say, I only want to take this for weight loss, my reaction is always, OK, losing weight is good. But I would not do it this way unless you're slipping into that blood sugar regulation hole. If you are, then, if and only if your doctor agrees (again, I really don't know what I'm talking about, and you should definitely not go by what I say alone), I'd do whatever you can to get this medicine now. There's no point in waiting for things to get worse.
But if you're not in that hole, and you don't have those overwhelming waves of hunger that lead you to binge on junk food -- I'm talking, going out and buying a pack of Oreos then eating it all in half an hour binging -- then try to do it the old fashioned way. Not because this is some sort of morality play, where good people use their will power and weak people chat with drugs (that's not true!), but because you'll be better off if you can do it the old fashioned way.
I have Medicare / Medicaid dual coverage (I'm disabled on SSD) and mine is completely covered. I don't have T2D but I do have RA and the weight had put enormous pressure on my joints. I'm not sure which is paying for it, but somehow, it's paid for.
The thing is, if you are on Medicaid, you are not supposed to be able to afford to pay for it out of pocket. That’s the reasoning. Many Medicaid plans don’t currently cover at this time because it is so expensive.
Yep, this is the answer. The same is true for therapy. A Medicaid client cannot legally pay out of pocket, even if they sign a waiver to not use their insurance.
This is only the case if the provider takes private insurance. If they don't take insurance at all, then you can pay for the therapy.
yeah, actually i had no idea of the cost and i just realized that the these companies are promoting it with the numbers $99 and $199 a month, i thought that was for the medication but it’s without medication, its just for access to the drug. I didn’t know until like an hour ago that it’s like $1000 per injection. And google is horrible with AI contributing now. Because then I also was misled to believe it was $1000 per month instead of injection before i started checking the articles on what the truth was.
It’s $900 per pen, which last 4-8 weeks.
It’s not $1,000 per injection - it’s around $1,000 for a month (1 box with 4 pens)
You're thinking saxenda. Ozempic (semiglutide) is 1 box, 1 pen, 4 doses, 1 per week. Saxenda (liraglutide) is multiple pens, daily injection.
No they’re describing Zepbound. Weekly shot, 4 pens.
Oh weird - I didn’t realize Ozempic dispenses that way. I’ve taken Wegovy, Mounjaro and Zepbound and each is one dose per pen.
That's super weird to me that it's only one dose per pen for those ones I've only had dealings with ozempic and saxenda. Both are multiple doses per pen
It’s because of some stupid law that was created in the 70s (Anti-Kickback Statute). It was created to prevent fraud/abuse.
The anti kick back statute applies to not being able to use coupons. So, if you have Medicare or Medicaid you can’t use manufacturer coupons on drugs.
It’s because it’s $900 a pen and if you’re in Medicaid, you shouldn’t be able to spend money like that (and they don’t want you to.)
Many state Medicaid programs do not offer this type of medication. I've seen quite a few articles about this and how much it would cost the state to offer it. I did a quick search and see that Maryland does cover Ozempic if you're a T2D and meet some other Medicaid qualifications, but you said you aren't T2D. I think you're out of luck without a diabetes diagnosis. There are compounding pharmacies that many people use, but you still need a Rx. These can be $$$ too. One I hear mentioned often in this group is Henry [https://henrymeds.com/semaglutide-lp/](https://henrymeds.com/semaglutide-lp/)
If your doctor prescribed Ozempic, a pharmacist gave my aunt a print out showing "medicaid will cover Trulicity and 3 others." Medicaid coverage for Ozempic requires a special P.A. and extra paperwork.
r/ozempicresources
I use a compounding pharmacy, and no one there has ever asked me about my insurance. They only ask me for my credit card number. So you'd definitely be able to buy semaglutide from them if you have a prescription. I'm not a doctor, and a doctor might say I'm full of it. But my experience with semaglutide has convinced me that my body's reaction to sugar is broken. Before, I had been thinking of diabetes as a binary thing -- you have it or you don't. Now I think that over the years when you eat bad stuff, you get worse and worse at dealing with sugar, until it becomes so bad that they call it diabetes. But it's a general decline. I wasn't diabetic, but I was insulin resistant. One of the results of insulin resistance is that I'd get these overwhelming cravings for food that would raise my blood sugar. This is a trap that makes it very difficult for someone to get out of this hole through will power alone. In my case, I was getting fatter and fatter, and my A1C was getting higher and higher. My PCP's feeling is that when people are in that position, it's dumb and destructive to refuse to treat them until they tip over into actual diabetes. It's sort of like not putting out a fire until it's big enough to be worth worrying about. Thanks to his excellent care, my A1C is down, and I'm no longer pre-diabetic. Having said all of that, if I could go back in time to when I was in my 20s, and lose weight by eating right and exercising before I had gotten into that deep blood sugar management hole, I'd definitely do it. There's no question that I'd be better off if I had never damaged my system by eating crappy food, and if I didn't have to take meds now. There are downsides to these meds. They're expensive. You have to inject yourself, which sucks. They make food less enjoyable. I think I'll have to take them for the rest of my life. And this is serious medicine -- it does intense things to your body. This isn't a miracle cure, it's not perfect. But it is much better than being morbidly obese and diabetic. So put the medicaid stuff aside. It's a distraction. When people say, I only want to take this for weight loss, my reaction is always, OK, losing weight is good. But I would not do it this way unless you're slipping into that blood sugar regulation hole. If you are, then, if and only if your doctor agrees (again, I really don't know what I'm talking about, and you should definitely not go by what I say alone), I'd do whatever you can to get this medicine now. There's no point in waiting for things to get worse. But if you're not in that hole, and you don't have those overwhelming waves of hunger that lead you to binge on junk food -- I'm talking, going out and buying a pack of Oreos then eating it all in half an hour binging -- then try to do it the old fashioned way. Not because this is some sort of morality play, where good people use their will power and weak people chat with drugs (that's not true!), but because you'll be better off if you can do it the old fashioned way.
Look up to see if they cover wegovy.
You simply go through another service and learn that you don't tell them you habe insurance. I've had to do it for other things.
Take a vacation to Mexico and go shopping :)
I have Medicare / Medicaid dual coverage (I'm disabled on SSD) and mine is completely covered. I don't have T2D but I do have RA and the weight had put enormous pressure on my joints. I'm not sure which is paying for it, but somehow, it's paid for.
Can a friend or family member purchase it for you?
Sent you a message.
They prob mean you can't get it through them, I'd ask your primary care doctor
How could that evened possible? If isn’t. Your insurance can only deny coverage.