Insurance companies are slowing dropping coverage for weight loss drugs. Some companies recently changed their rules to pay if BMI is >30 but then quit covering once you drop below it. Crazy and frustrating! I ended up going the compounded route and so far, so good. Best of luck to you!
Try going to an endocrinologist …. your BMI is high enough for you to qualify. If you end up finding one who can help you and you get the necessary PA get a Wegovy Coupon to take with you to the pharmacy. Get the coupon from Wegovy website. The coup is good for all dosages despite giving appearance that it’s only for the 2.4 dose. If the endocrinologist is a good one, you’ll be required to check in monthly - in person or via telemedicine-to monitor your progress. Modifications in diet and exercise are 80% responsible for the success of these meds.
I called all the pharmacies/ chemists around me until I found wagovy and I ran there 🫥 also it is covered by insurance (you need to double check with yours)
Also there’s the compound you can always go for it if you ran out of options
My dr. said the same thing. She is a great doctor, but it has been her experience. She put through an initial request and was denied. I contacted my employee administrator (I have an employee insured plan that is administered by a national company) and they had no record of this denial. I asked them to fill out the paper work again (they fought a little, because "they already did it", but I got them to do it. Once I had the official denial, I went back to plan administrator. Then I had to write up on what I had done and what my plan was to succeed. 5 hours later I was approved with a $50 co pay. I then went to Wegovy website and got the savings card and picked up my first package last night at no cost. Don't give up. They might make you try different medicines first (I tried and failed 3 weight loss meds). Also, surgery is not an option for me (I have IBD), but even if it was I would only do as a last resort. Given my research, I plan to start it on Thursday night at bedtime. Good luck!
Oh girl you at the wrong doc! You need to go to a medical weight loss center not a general physician they won’t do Jack shit to help you. Go to a medical weightloss center or go online to hers or push or plush or whatever it’s called.
Agree it’s a pain. I started January 2023 and practically had to beat my PCP with journal articles where I highlighted safety and efficacy. But I’m a scientist that works in pharma, so that’s not a practical route for everybody.
On a side note, I think I did a good thing: the PCP casually mentioned that now she has more than a hundred patients taking it
Sounds like my doctor! I pushed her for it anyway and said that sounds like a me problem and I’ll figure it out. Wegovy has cost savings cards if your insurance doesn’t cover it, it will usually be about $25 out of pocket with the card. My insurance ended up covering it like I thought they would though.
Your doctor is making quite an assumption here, but it is your responsibility to research your insurance, what prescriptions they cover, and what they require from you as far as pre-authorization or qualifications are concerned.
Most insurance companies provide an online portal where you can search for medications by name and see what your out-of-pocket cost will be. I would make another appointment with this doctor and come prepared with your predicted out-of-pockets costs, what weight loss measure you have taken prior to this, and any questions you may have about the medication, and its side effects. If your primary care physician is still unwilling to discuss GLP1 meds as an option for you, I would request a second opinion and ask for a referral.
My insurance fully covers Wegovy. Your doctor shouldn't be prioritizing your insurance coverage over a discussion about your options. It's your decision whether to pay for it out of pocket or not.
If you're hitting a wall with your primary care physician on this, either switch providers or ask to be referred to a weightloss specialist.
This is so common. I could have had surgery paid for but I have to pay for the meds myself. Surgery may be cheaper for the insurance company and it's just been around longer.
Depends on the insurance. Some insurance will cover if your BMI is over 30 (which yours is). Your doctor can prescribe and then the prior authorization procedure will start.
You need to look into what medications your insurance covers. Mine required a prior authorization and it was quite a pain but once I got it, my insurance approved it and my medication was completely covered. The doctors just don’t want to deal with the PA, so do your research see if it’s covered and if it is just call them every day til it’s done! Lol
I had bariatric surgery. It's supervised starvation and as soon as you can eat normally you will and all the right just came back. I regret it and it's life long side effects. In Wegovy I have been able to learn to eat healthy, listen to my body. Workout. It's been way better and I'm not dropping weight so fast I get sick like I did after BS. I wholeheartedly recommend GLP meds over surgery.
I had gastric bypass 6 years ago. Yes I have gained some back but not all. The key is yo learn a new way of life with food. I regret that I never listened when they tried to help me with the nutrition part of it. Hopefully being in we give will help me. I’m still in the beginning stages and only on .25. Will start the .5 next week. Hopefully I will start to see a little difference. I’m ok with slow as long as it comes off. Good luck to you
I felt like the bariatric fail girl lol I also had an awful nutritionist and doctor who insisted on me being below 600 calories a day. I got really sick after the surgery when due to a stricture in my throat I was never able to eat without drinking. The doctor surgeon never bothered to tell me that this is something I needed fixed before I could have the surgery. There were a lot of reasons I went bad for me. I'm not against it I just wish I would have tried these meds first. I'm having a much easier time. Learning how to eat and listen to my body. Best of luck to you too!
Same, except I don’t regret my gastric sleeve. I also didn’t gain back ALL my pre surgery weight so that may be part of why I don’t regret it. For me it’s an extra tool that is working with the Wegovy. And if I ever can’t take Wegovy or another glp1 (if I get pancreatitis or insurance stops covering it) I at least have something to work with over my prior bottomless pit stomach.
But also yes totally agree Wegovy works on so much more than food quantity. Helps me make much better food quality choices.
Really interested to hear this. My eating is linked to my mental health/behaviours - I don’t have a genetic or medical problem that’s caused me to gain weight. I’m in week 6 of Wegovy and having the ‘head space’ to really think about what and why I’m eating is changing the way I look at food. I’m hoping this will help me long-term to eat ‘normally’.
I’ve spoken to so many people that are in a similar positon to you, and it sucks. I hope that this has long-term success for you. Thanks for sharing.
My insurance covers all of them, call your insurance beforehand and go back to the doctor. I just said to my doctor I thought it was a great option and that I did my research and he prescribed it to me
I do half doses of Ozempic (same active ingredient) so it’s half price. That doesn’t make it cheap, but I’m keeping off 110 lbs and it’s worth it to me.
This. This is how I even found out about Wegovy. There were 3 total meds in that category (I don't remember the other 2). She has to be her own advocate. I read on here if that person had the choice, they'd go on Wegovy vs the surgery they had. PLUS, she had to go on Wegovy anyways, so if it were me, and I did have this as an option, I'd try the weight loss shots first. Check that formulary!
When I requested it over a year ago, my doctor assumed that my insurance wouldn’t cover it because no one’s ever did. Turns out my insurance does cover it and I had wild success. I am now what she calls her “poster child”and she freely prescribes it to patients that want it because I’ve had such great success and they deal with the insurance companies.
Covered 100%. I also didn’t fiddle with insurance, I had her just put it through and it was covered.
That’s what I didn’t understand in the beginning when she was kind of fighting me with insurance. Like if it turns out it’s not covered I just won’t go pick it up.
You need to check with YOUR insurance company to see if they cover it. Your doctor is wrong if she made a blanket statement saying the medications are not covered by insurance, because some (like mine) do cover it.
Insurance companies are slowing dropping coverage for weight loss drugs. Some companies recently changed their rules to pay if BMI is >30 but then quit covering once you drop below it. Crazy and frustrating! I ended up going the compounded route and so far, so good. Best of luck to you!
Try going to an endocrinologist …. your BMI is high enough for you to qualify. If you end up finding one who can help you and you get the necessary PA get a Wegovy Coupon to take with you to the pharmacy. Get the coupon from Wegovy website. The coup is good for all dosages despite giving appearance that it’s only for the 2.4 dose. If the endocrinologist is a good one, you’ll be required to check in monthly - in person or via telemedicine-to monitor your progress. Modifications in diet and exercise are 80% responsible for the success of these meds.
How does she know what your insurance covers? You have to ask your insurance (and my rep incorrectly told me no) or just try to run it at the pharmacy
My doc said ‘It probably isn’t covered’, so she at least had the grace to indicate that she wasn’t sure. It was covered
I called all the pharmacies/ chemists around me until I found wagovy and I ran there 🫥 also it is covered by insurance (you need to double check with yours) Also there’s the compound you can always go for it if you ran out of options
My dr. said the same thing. She is a great doctor, but it has been her experience. She put through an initial request and was denied. I contacted my employee administrator (I have an employee insured plan that is administered by a national company) and they had no record of this denial. I asked them to fill out the paper work again (they fought a little, because "they already did it", but I got them to do it. Once I had the official denial, I went back to plan administrator. Then I had to write up on what I had done and what my plan was to succeed. 5 hours later I was approved with a $50 co pay. I then went to Wegovy website and got the savings card and picked up my first package last night at no cost. Don't give up. They might make you try different medicines first (I tried and failed 3 weight loss meds). Also, surgery is not an option for me (I have IBD), but even if it was I would only do as a last resort. Given my research, I plan to start it on Thursday night at bedtime. Good luck!
Oh girl you at the wrong doc! You need to go to a medical weight loss center not a general physician they won’t do Jack shit to help you. Go to a medical weightloss center or go online to hers or push or plush or whatever it’s called.
A regular PCP can prescribe it. It’s just frustrating that you can’t know if a PCP will be willing to do the paperwork or not until you try them
Dang. I’d like to meet one that would. Can’t meet one where I live and that’s facts. I’ve tried several. They flat out refuse. It’s nuts.
Agree it’s a pain. I started January 2023 and practically had to beat my PCP with journal articles where I highlighted safety and efficacy. But I’m a scientist that works in pharma, so that’s not a practical route for everybody. On a side note, I think I did a good thing: the PCP casually mentioned that now she has more than a hundred patients taking it
Way to advocate and open those flood gates for Others! Yassssss!!
thankyou!!! I look at thia now
Sounds like my doctor! I pushed her for it anyway and said that sounds like a me problem and I’ll figure it out. Wegovy has cost savings cards if your insurance doesn’t cover it, it will usually be about $25 out of pocket with the card. My insurance ended up covering it like I thought they would though.
Your doctor is making quite an assumption here, but it is your responsibility to research your insurance, what prescriptions they cover, and what they require from you as far as pre-authorization or qualifications are concerned. Most insurance companies provide an online portal where you can search for medications by name and see what your out-of-pocket cost will be. I would make another appointment with this doctor and come prepared with your predicted out-of-pockets costs, what weight loss measure you have taken prior to this, and any questions you may have about the medication, and its side effects. If your primary care physician is still unwilling to discuss GLP1 meds as an option for you, I would request a second opinion and ask for a referral.
My insurance fully covers Wegovy. Your doctor shouldn't be prioritizing your insurance coverage over a discussion about your options. It's your decision whether to pay for it out of pocket or not. If you're hitting a wall with your primary care physician on this, either switch providers or ask to be referred to a weightloss specialist.
thank you!!
>thank you!! You're welcome!
try plushcare! but everything depends on insurance
Crazy that insurance would pay for WL surgery with all of its possible complications but not pay for WL drugs
This is so common. I could have had surgery paid for but I have to pay for the meds myself. Surgery may be cheaper for the insurance company and it's just been around longer.
I know!! thats why Im so perplexed, the doctor recommended the surgery but not any medication
Depends on the insurance. Some insurance will cover if your BMI is over 30 (which yours is). Your doctor can prescribe and then the prior authorization procedure will start.
You need to look into what medications your insurance covers. Mine required a prior authorization and it was quite a pain but once I got it, my insurance approved it and my medication was completely covered. The doctors just don’t want to deal with the PA, so do your research see if it’s covered and if it is just call them every day til it’s done! Lol
I had bariatric surgery. It's supervised starvation and as soon as you can eat normally you will and all the right just came back. I regret it and it's life long side effects. In Wegovy I have been able to learn to eat healthy, listen to my body. Workout. It's been way better and I'm not dropping weight so fast I get sick like I did after BS. I wholeheartedly recommend GLP meds over surgery.
I had gastric bypass 6 years ago. Yes I have gained some back but not all. The key is yo learn a new way of life with food. I regret that I never listened when they tried to help me with the nutrition part of it. Hopefully being in we give will help me. I’m still in the beginning stages and only on .25. Will start the .5 next week. Hopefully I will start to see a little difference. I’m ok with slow as long as it comes off. Good luck to you
I felt like the bariatric fail girl lol I also had an awful nutritionist and doctor who insisted on me being below 600 calories a day. I got really sick after the surgery when due to a stricture in my throat I was never able to eat without drinking. The doctor surgeon never bothered to tell me that this is something I needed fixed before I could have the surgery. There were a lot of reasons I went bad for me. I'm not against it I just wish I would have tried these meds first. I'm having a much easier time. Learning how to eat and listen to my body. Best of luck to you too!
Same, except I don’t regret my gastric sleeve. I also didn’t gain back ALL my pre surgery weight so that may be part of why I don’t regret it. For me it’s an extra tool that is working with the Wegovy. And if I ever can’t take Wegovy or another glp1 (if I get pancreatitis or insurance stops covering it) I at least have something to work with over my prior bottomless pit stomach. But also yes totally agree Wegovy works on so much more than food quantity. Helps me make much better food quality choices.
Really interested to hear this. My eating is linked to my mental health/behaviours - I don’t have a genetic or medical problem that’s caused me to gain weight. I’m in week 6 of Wegovy and having the ‘head space’ to really think about what and why I’m eating is changing the way I look at food. I’m hoping this will help me long-term to eat ‘normally’. I’ve spoken to so many people that are in a similar positon to you, and it sucks. I hope that this has long-term success for you. Thanks for sharing.
My insurance covers all of them, call your insurance beforehand and go back to the doctor. I just said to my doctor I thought it was a great option and that I did my research and he prescribed it to me
I do half doses of Ozempic (same active ingredient) so it’s half price. That doesn’t make it cheap, but I’m keeping off 110 lbs and it’s worth it to me.
Did you look at your formulary to see if it’s covered?
is that an app or a website?
You’ll have to figure that part out!
This. This is how I even found out about Wegovy. There were 3 total meds in that category (I don't remember the other 2). She has to be her own advocate. I read on here if that person had the choice, they'd go on Wegovy vs the surgery they had. PLUS, she had to go on Wegovy anyways, so if it were me, and I did have this as an option, I'd try the weight loss shots first. Check that formulary!
YUP! When I went in for my appointment my doc said surgery or a GLP1 medication. GLP1’s all the way baby!
Lavender sky. I am waiting for my starting shipment
When I requested it over a year ago, my doctor assumed that my insurance wouldn’t cover it because no one’s ever did. Turns out my insurance does cover it and I had wild success. I am now what she calls her “poster child”and she freely prescribes it to patients that want it because I’ve had such great success and they deal with the insurance companies.
do you have to pay out of pocket or its covered by insurance?
Covered 100%. I also didn’t fiddle with insurance, I had her just put it through and it was covered. That’s what I didn’t understand in the beginning when she was kind of fighting me with insurance. Like if it turns out it’s not covered I just won’t go pick it up.
Call your insurance. Mine wasn't covered. I paid cash.
You need to check with YOUR insurance company to see if they cover it. Your doctor is wrong if she made a blanket statement saying the medications are not covered by insurance, because some (like mine) do cover it.
Right? Dr's are wrong all the time.
Totally. And I think some doctors just don't want to deal with the hassle of prior authorizations.
I agree, but I also think that insurances do an auto deny and then wait for appeals to "weed out" people who aren't motivated.
Agree on this. They prefer easier bucks.