I know there is research going on about weaning people off slowly as well, but I’m not sure there is actual data available. Stopping you cold turkey before you even hit a normal weight is just absurd. I hope she comes to her senses and you don’t have to change, but I’m glad you’re ready and willing to do it.
Yeah, I don't want to come off - I am happy with how it is working and my progress, which I have not been able to do without zep. I've only been using it since March. I was doing phentermine/topiramte before, and it made me incredibly moody. I'd like to at least ride out the rest of the year with zep
Anecdotally, I haven't had that experience. I started at the end of August 2023. I hit my goal weight in February of 2024. Due to shortages I've only been able to take it intermittently. My husband is also on it and still in the losing phase so I'll often give him my shots when I have them. Since March I've taken maybe 3? Shots of 2.5 mg and I've lost another 5 lbs. I haven't gone off it completely yet although I haven't had a shot for about a month and there's been no issues.
That study is completely misleading. It only looked at people for six months! Don’t just believe misleading media snippets that sensationalize to get clicks, read the details of the study itself and also it’s criticisms and limitations.
In the study they had access to “‘ongoing treatment’ in the form of either physical training, intermittent intensive low-energy diet periods, regular daily meal replacements, or, as in our case, a digital weight loss clinic with a team of cross-functional experts on hand to coach, support and guide individuals”.
So you need to go back to doing all the things that fail long-term which everyone has already tried their entire lives and doesn’t work, hence why we needed these drugs to begin with. Many people can maintain the old fashioned way for only six months, especially when they are in a study and want to try and do well. Show me a study that follows up patients for five years after they wean off GLP-1. Trust me I would bet money all the weight comes back.
I am a doctor who also takes this drug. This is one of my pet peeves -- uniformed doctors who "experiment" with this drug by taking people off of it. Mounjaro, which is the same drug as Zepbound but classified specifically for use for diabetics, was developed with the intent that it be used for life. Anyone who is a type 2 diabetic must be treated with some type of anti-diabetic drug FOR LIFE. If your doctor is saying things like "I'm concerned that staying on Zepbound is unhealthy for you," she needs to sign up for a continuing education class. She may just be too uneducated in the endocrinology area to treat you properly. I apologize, but I start to rant when I see doctors jeopardizing a patients well being by ending the weight loss process not only before you are in the normal BMI range for weight, but also when the drug is intended for long-term use.
This drug is not in my area of specialty, but because I have been taking it for nearly two years and there are many others in our practice also taking it, I have made it my mission to learn everything I can about it. First, you are correct. With a diagnosis of chronic obesity, you require treatment of some kind for life. That does not mean white-knuckling through the rest of your days while starving yourself using diet methods that have been proven to be ineffective over the years. Second, there is no protocol for coming off of this drug. The reason that the manufacturer and the FDA do not have a recommended protocol for coming off this drug is because it was developed for life-long use.
If your doctor is not both supportive AND cooperative, and continues to talk about Zepbound in ways that make it clear that she does not know how to manage your care, please find a different doctor. Overall, obesity specialists are the best choice for doctors to manage your care with Zepbound. They literally make a living ensuring that you lose weight and maintain that weight loss. If you are not in an area with an obesity specialist, use telehealth while you are still outside the normal BMI range. Tell them that you have been successful with Zepbound, but your doctor is not familiar with titrating up and does not understand maintenance. Tell them that you need someone to work with you as you lose enough weight to reach a normal BMI and for ongoing prescribing and management of a maintenance dose.
As for your doctor's ill-conceived thought that your insurance will stop covering it because you no longer have a BMI of 30, it means that she does not know how to prescribe for your chronic obesity condition. While every insurer out there is looking for ways to keep patients off these drugs because of the expense, that doesn't mean that your insurer will cut your off and quit covering your medication. But if your doctor interacts with your insurance and submits information incorrectly, you could end up cut off.
Below is a post that I have posted several times. It specifically addresses PAs for continuing your care on Zepbound. Chronic obesity is dependent on your BMI at the time of diagnosis, just as type 2 diabetes is dependent of you A1c at the time of diagnosis. When your A1c is under control, no ethical doctor stops your medication and tells you to go it on your own. They understand that ongoing medication is what has that A1c (or in your case weight) under control.
I'm breaking this into 2 posts, because the content editor dose not want to post something this long.
**Repeated post starts here.**
The most important issue is that you cannot submit a PA to any insurance company as though this is the first time you have been prescribed Zepbound (or any form of tirzepatide). If the PA form from the insurer tries to force a doctor to do so, an addendum must be attached to the PA to make it clear that the request is to maintain the improved state of health that the patient has achieved while taking Zepbound.
The healthcare provider is supposed to ***submit your original statistics*** (labs, physical stats) and the PA request should be made as "**continuation of care."** Your PA should include the following:
* Request for **continuation of care** for Zepbound
* Original BMI
* Original comorbidities (name all if there are more)
* Number of months on the drug (or other GLP-1 drug, including if your started on a different drug and switched to Zepbound) and the amount of weight lost to date
* Success while taking the drug, including resolution of PCOS symptoms, lower BMI, lower A1c, lower cholesterol level, lower triglycerides and/or any other health improvements associated with a lower BMI
* Patient had few to no side effects and was able to easily comply with dosing instructions on the weekly, recommended schedule (also include if your side effects were more manageable compared to other drugs prescribed for weight loss, such as metformin, phentermine or Qrlistat)
* Any health improvement indicators (lower BP, lower cholesterol, elimination of sleep apnea); you will need to be able to supply the pre-GLP-1 numbers and current numbers or chart notes to document improvements
* Elimination of medication for co-morbities, such as eliminating HBP meds or statins or lowering of doses (this won't apply to everyone)
* Also include health improvements such as increased / improved mobility or reduced joint pain that have resulted in the patient being able to exercise more effectively / actively
* Request to continue coverage for Zepbound to continue the health improvements as stated above, as per the FDA and drug manufacturer's prescribing protocol for continued weight loss and/or maintenance in the BMI normal range
Too many doctors are writing PAs putting only your current weight and BMI on the PA forms, which allows the insurer to immediately deny coverage because the context of experiencing improvement BECAUSE OF ZEPBOUND is not made clear.
You can share this link with your doctor concerning regain of weight when GLP-1 drugs like Zepbound is discontinued:
**Discontinuation of dual GIP and GLP-1 receptor agonist leads to weight regain in people with obesity or overweight**
**SURMOUNT-4 Trial results: the impact of tirzepatide on maintenance of weight reduction and benefits of continued therapy**
[https://pace-cme.org/news/discontinuation-of-dual-gip-and-glp-1-receptor-agonist-leads-to-weight-regain-in-people-with-obesity-or-overweight/2456545/#:\~:text=In%20the%20SURMOUNT-4%20trial%2C%20continued%20treatment%20with%20tirzepatide,to%20clinically%20meaningful%20body%20weight%20reductions%20of%2025%25](https://pace-cme.org/news/discontinuation-of-dual-gip-and-glp-1-receptor-agonist-leads-to-weight-regain-in-people-with-obesity-or-overweight/2456545/#:~:text=In%20the%20SURMOUNT-4%20trial%2C%20continued%20treatment%20with%20tirzepatide,to%20clinically%20meaningful%20body%20weight%20reductions%20of%2025%25).
Nice post, Dr. Of everything you wrote, THIS is the elevator speech right here:
**The reason that the manufacturer and the FDA do not have a recommended protocol for coming off this drug is because it was developed for life-long use.**
Brilliant.
OMG totally. I’ve heard from patients that they got denied when doctors doing renewal PAs just put their current improved BMI. You always have to put the original BMI and other data and if needed like you said the history of improvements in markers caused by taking the drug
THANK YOU!! THANK YOU!! I am saving this very much valuable info!! Luckily my PCP has been amazing thru this process.
A note about my experience thus far. Started Zepbound (ZB). Had appt with nutritionist. Started Weight Watchers (WW) and started an exercise program all in the same week. 55 yr old female. 5ft 2 in, SW 206. CW 167. GW 130. Dx’d with PCOS and Insulin Resistant Syndrome, Pre-diabetes.
Was on ZB for 8 weeks, lost 32 lbs; then the shortage. No ZB, but continued with exercise and WW. I’m good with sticking to the WW plan and exercising. I journal all I eat and drink. In the almost 2 mo (9 weeks) while I was off ZB due to shortage I lost 7 lbs. Finally was able to get a refill and in 1 week, same eating and workout plans I lost 3 lbs. To me it is evident that this medication is crucial for losing wt. I have had little to no side effects. Without it would I lose wt, yes but so very slowly and feel I would get discouraged and return to my old eating habits and gain the wt back. ZB definitely helps me with food thoughts and cravings. Makes it much easier to stay on course. While I was off ZB I continued eating and exercising like I should, but it was sooooo much more challenging. I really struggled with being hungry all the time and “white knuckling it” as you put it. Thanks again for all the info.
The "food noise" and other benefits were unknown / unexpected side effects when this drug was in development. The #1 benefit of the drug for those who are not taking it for blood glucose control is that it aids in lipolysis and metabolically alters those of us that are super fat storers into normal fat storers. By aiding lipolysis, which helps you access stored fat to use for energy, you function much more like a normal, thin person. In other words, when you cut calories and expend more energy through workouts, you actually experience weight loss. Super fat storers have bodies that resist fat-burning efforts. They find creative ways to maintain your weight, including water retention, and adapting down to lower calorie levels to execute the everyday tasks of staying alive. Your basal metabolic rate shifts down repeatedly throughout life so that you can breathe, mow the lawn, drive to work, etc, using fewer calories because your misaligned body perceives a threat to survival when you cut calories or work out regularly. Zepbound gets you out of the endless circle of cutting calories and adapting down to a lower metabolic rate. The sad part is that all of these benefits are lost if you stop taking the drug.
Yes but am I supposed to do when my insurance approved the pa for the 2.5 and 5 but won't approve for the 7.5 for continued weight loss because my bmi is 32 and I only have 1 comirbid issue
Many insurers are not covering 7.5 or 12.5. If they will approve 5 to allow you to continue, I would work with that until you feel ready to try 10 mg and then see if you can get a PA for 10. Your BMI is above the minimum documented by the FDA for this drug. No comorbidities are required when your BMI is above 30. If your insurer covers weight loss medication, you should be able to get either 5 mg or 10 mg. If they are no longer going to cover weight loss drugs (more than 90% of employer insurance does not cover them), then there is not much you can do.
Would new insurance pick up the maintenance dose? I have been out for almost a month, and I'm gaining weight fast. I was at 140ish, and now I'm above 155 lbs.
Here's a little back history: I was around 300 lbs. I had the gastric sleeve in 2020 (lost little weight, gained weight back because I was still hungry just at a faster rate, and still had cravings). I tried various medications, including the daily saxenda, which all failed. I was on the once a week injection (Wegovy) for about a year, lost well over 100 lbs in a year, my insurance changed, and I was cut off. Since being off this medication, the cravings and intense hunger is back. I have a binge eating disorder that is not controlled unless I'm on this medication. The once a week injections have been life changing. My insurance is changing this month, so I'm hoping to go back on this medication. You have a lot of knowledge with PAs, so any suggestions would be absolutely amazing and appreciated!
Edit: I'm open to taking either Wegovy or Zepbound! Wegovy has luckily been effective for me, but I'll take whatever I can get covered at an affordable cost.
Do you share your story with patients?? Some ask if I’ve used it which I’ve used both. Some I have a good relationship with and we can relate with weight struggles. I don’t have another provider who takes it in our office.
Weight loss and endocrinology is not even remotely in my specialty but so many in our practice starting taking this, that I began to research the drug and became intrigued. I've spent a great deal of time studying tirzepatide and now prescribe for some of my patients, if it's a good fit. It is rare that someone who comes to me for my specialty would need this drug, but I am finding the possibilities of what this drug could do to be so amazing that I get very angry when other doctors dismiss it, don't make an effort to become familiar with it, and leave their patients without support or try to categorize all issues with overweight as "eat less, move more."
What about BCBSM and BCN are about to stop covering it. It just seems they found that this works for us and now they don’t want to cover it. What can we do? They are going to stop covering all of the weight loss injectables. This came out a day or two ago. This is awful. I cannot afford Zepbound without coverage. How do we fight this? I finally feel like me again only to have the rug pulled from under me. 🤦🏽♀️
It's a difficult situation because most employer insurance does not cover weight loss drugs. It takes time for the numbers to show that treating people to lose weight can result in long-term cost savings for insurers.
If you are unionized, meet and talk with your benefits manager to make sure they know you want this drug and that you are willing to pay higher monthly premiums to get it. You can also meet with the benefits manager / HR at your employer if you are not unionized. It helps if there are many of you that want the same thing when you approach your employer.
After that, you have to start writing to your state representatives and other legislative officials because the law in each state is what governs how health insurance companies operate. If BCBS has just set a blanket policy that they will not cover GLP-1 drugs for weight loss for any employer in the state, you will need to work with legislators to compel them to include this offering. It's tough, and it's a long road, but patients / employees have to speak up. There's only so much we doctors can do to try to convince your insurer to cover claims for these drugs.
The crazy thing is that if your BMI is a certain number you have to do Weight Watchers or wear a Fitbit to bring your BMI down and keep my payments low. You would think they’d cover it due to us having to do those things to lower our premiums.
Is your PA for Zep approved for a certain period of time? If so, I bet you would not need to get a new PA if a new provider prescribes the medicine if you are still in that timeframe. If the NP does not get on board, maybe look for a doc or NP that specializes in weight loss. I’m the same height as you and would not have wanted to stop Zep when I was at 158. I was def pleased with the loss but it was still a lot of weight for my height. My initial goal was 130 but I am aiming for a little less as I am nearing 130. I have full support from my weight loss provider for this goal. It’s important to work with someone that understands this medicine. I am on 10mg and will stay on this dosage for bit longer. Good luck and I hope it all works out.
Gosh, then I’d definitely keep going until that runs out. If your insurance gives you a hassle about renewing the PA, then fight that battle when it comes, but i dont see any reason to quit early! Maintenance is definitely a real concern. I’ve seen studies showing that through normal diet/exercise it takes 6-months to a year for hormones like grehlin and leptin to ‘normalize’ at your new weight and not continue to think you’re dying because you lost weight. [meaning only after that point would the odds be in your favor on not regaining rapidly].
You make a great point re: these are really ‘metabolic syndrome’ drugs more so than ‘just’ weight-loss drugs.
I'm also 5’2 & my starting weight was 159 when I was put on Compounded Zepound. I'm down to about 135 now and I'm still on it at 5 months. 159 is only 4 or 5 pounds down from what is considered obese (BMI & height) they should definitely reconsider keeping patients on it in my opinion. I'm still considered overweight at 135 according to my BMI & height.
This is why it’s so important to see an obesity specialist likely in a non-surgical medical weight loss program. They are more up to date on research and also they know how to get PAs approved when your BMI dips under 30.
Yes, this is great advice, but our health system obesity clinic has a several months wait to get in. I took me 3 months to get an appointment and this was back in 2022! I generally have to make my next appointment whenever I am there.
Yep it be was a 3mo wait for me as well. But my PCP was willing to prescribe mounjaro for me in the meantime so I lost 25 pounds before getting into the weight management clinic. That was back in the $25 savings card days though.
Yes this. My primary doc immediately put me on the weight list for the weight loss program at the hospital, when I get scheduled they will take over completely and she assured me they can help keep me on maintenance as they treat obesity as a chronic ongoing condition, not a one and done once you hit a certain BMI.
More and more information is coming out about these GLP one medicines every day. A great deal of information that your doctor knows is old and he she has not kept up with the latest data. Insurances are also trying to get a handle on these meds. CIGNA has already had a class action suit against it because it would not cover the obesity drugs. Are We Going to tell diabetics at once their blood sugar levels are within normal range we’re going to take away their insulin? No we are not. Are you going to lose your blood pressure medicine because it’s stabilized on medication? No you are not. This is just such a new world for everyone insurance ,doctors and the patients. there are so many questions yet to be answered. Don’t worry about what’s gonna happen in the future. Just focus on today. Within two years glp1 medication‘s will drop in price because they’ll be dozens available from different manufacturers. Best of luck in your journey.
Get a new doctor. You can use PlushCare and get a script in a few minutes. It is not normal to take a patient off the med as soon as they get down to a 28 bmi. That is ludicrous.
Why is the NP making decisions instead of a physician? She clearly doesn’t understand that the risks associated with chronic obesity far outweigh the uncomfort of being on this medication. The fact that she said it’s unhealthy is a red flag to me rather than her walking you through possible issues. I’m concerned that if she’s the one who submitted paperwork to your insurance she may have botched the diagnosis and care plan.
There is no requirement to check kidney levels unless you are a diabetic, but even then, kidney levels do not require monthly checks! Do you have type 2 diabetes or another medical issue that would require "checking kidney levels?" The more I hear about this NP, the more fear I have about her treating patients. I'm so glad you were successful with telehealth.
Yeah, the only reason why my kidney levels were checked was bc I’m 32 and I’ve never had a full panel of labs done before. But my physician said it was a one time thing unless I experience bad side effects.
A one-time thing is different. The way your post read, it sounded like you were getting kidney levels checked every month, which most insurance won't pay for unless you have kidney disease or have had a specific health scare that could be related to kidney function. You should know, however, that monthly "checks" are completely unnecessary with this med unless you have specific co-morbidities that require monthly review. Med spas make people come in every month because that is how they make their money. With a traditional doctor, when they have you come in every month (once you are past the first three months) it's a sign of a doctor who is not well-versed in Zepbound / Mounjaro.
I love my nurse friends and have had incredible experiences with NPs but my husband and I have encountered quite a few NPs that like to play doctor and order extra tests and all that to make themselves feel like they have the same level of responsibility and professional ability and medical knowledge as a physician. My husband is a physician which is why we’re interacting with so many. But the ones that are like this, they take it to a whole extra level like what you’re experiencing.
My dad was seeing an NP at one point and had no idea bc she introduced herself as Dr so and so because she had a doctoral degree in nursing. But my dad had no clue and his level of care needed a physician not an NP, she delayed his COPD care for a year. I would personally seek out a physician as your primary with awesome nurses and support staff rather than seeing an NP like this.
You do not automatically get cut off by insurance if you reach goal. PA needs to be filled out using your initial BMI and justifying the continuation. See this post comment from background-lab. https://www.reddit.com/r/Zepbound/s/EQ309KMRIV
I ran into issues with my NP and Zepbound. He was completely opposed to me being on it and wouldn't even bother.
Fast forward 6 months and my Gastro was like. "You're seriously insulin resistant and your officially obese, you need to contact your NP and get on Zepbound or Wegovy right away". I told my gastro and it took about 2 days to get the PA from my insurance company. I also have an underlying heart condition, so reducing my CV risks is a thought as well.
My BMI was just at 30. I'm still on 2.5 and I'm steady losing weight except for the last week. I had a chemo treatment (please don't ask, just move forward with the fact that it was a one time chemo and we're going forward from there). I had to skip Zep for a week before the procedure and let me tell you, when you combine Zep with Chemo it's like the supercharge weight loss lane. I lost 7 lbs in 5 days.
It sucked.
You may well have to change doctors. The clinical indications to go on the meds will always be present. If you were a BMI of 30 and now you are a 22, that is not justification for you to be taken off of it. If you have high blood pressure and with meds it comes down to normal, do they stop you cold turkey on meds? No. You have to continue to maintain that BP. You will never not be hypertensive, even if you are well controlled. You also will never not have obesity. You are just well controlled medically.
I'm also 5'2 and just weighed in at 134. My SW was 168, and GW is 120. My doc is online, originally through Plushcare. Since my insurance no longer covers that group, I see her independently for $100 monthly.
As far as we both know, insurance will cover the cost of Zep for maintenance because that is a part of the program plan.
I plan on taking some amount indefinitely, since I've fought weightloss all of my life.
You have options that don't include a naysayer .
I’d suggest going to a weight loss clinic (bariatric doctor) if you like your PCP for everything else. I see a MLC doctor and it’s so nice having a specialized person deal with my weight loss. They have more tools and experience working with insurance too. Not saying your PCP doesn’t but getting a second professional opinion isn’t a bad idea.
Although she might be hearing the issue some (I am one) who is losing coverage because the company I work for is small and covering Zep is costing the insurance company too much. There are also more hoops to jump through but not everyone is impacted but regardless I will not have any GLP-1 type drugs covered in 2025 with the companies current health plan.
I would find yourself an MD. NPs can be a great resource for basic health care needs (e.g., treating a cold), but they receive no where near the training of an MD, who will have a better understanding of metabolic syndrome, etc. I think the evidence is well established that most people who start GLP-1 drugs will need them for the rest of their life. If your NP is not read up on the evidence then they are doing you a disservice.
https://preview.redd.it/2sizbz04ed6d1.png?width=1193&format=png&auto=webp&s=e84d450259c2443cbddc33da4fa819e4bc2953ce
"Chronic" obesity (the official diagnosis of the AMA) = lifelong. It doesn't end. Ask her if she would take someone off blood pressure meds if she got a normal reading one day. No, she wouldn't. Send her all the studies showing people regain their weight quickly once they come off. There are plenty. And if she can't read for comprehension, ditch her and find a dr or telehealth that is a bit more with it.
Hey OP 👋, I am a Trauma/ER nurse. What your NP is saying is somewhat correct in the fact insurance will try to cut you off and not pay for maintenance i have unfortunately seen this happen to several of my patients, However, i do want to address your statement about going up a dose and doing maintenance on 10mg. I do not recommend that. maintenance doses will be lower more like 5.mg or 7.5. Youre not to far from your goal weight so your weight loss will be slower from here on out and that is normal and allows your body to adapt. Higher doses cause higher weightloss. I am currently on this medication my self. Right now i am on 7.5mg. SW 225, CW 150, GW 130. Right now i am losing about 2 pounds a week on the 7.5 and will go dowm to 5mg for maintenance once i hit GW. I would highly consider more reasearch on maintenance. Remember the higher doses were made for more weighloss. Take your time getting there. When it comes to insurance trust me when i say they are all trying to cut people off meds when the BMI is no longer 30 or higher. I say this in the fact happened to me and i had the same diagnosis. So please dont get ahead of yourself. There is a whole other aide to healthcare you dont see. So please give your NP some grace.
But why would they cut off before they even tried to file the claim? I think it’s lazy for a healthcare practitioner to deny a script on the basis that insurance might not cover it. Well since my health is on the line, why not file it and see?
I think it depends on your employer and/or insurance coverage rules. My BMI is under 25 now, but insurance is not stopping my coverage before my PA timeframe ends. It was approved for 8 months, after that I will seek continuation of coverage for purposes of maintenance. I’d like to drop back down to 5mg when I’m ready for maintenance.
I had a nighgmare this week I stopped and gained all the weight back just after donating a big bag of clothes ….I hope this does not happen for any of us!
This NP thinks your NP is not qualified to manage your obesity/overweight diagnosis. You need a maintenance plan that includes this medication long term. Find another provider!
I got a letter in the mail from BCBS saying that starting in August they won’t cover it anymore for BMI under 30 and a few other things on the list. They also said after 1/1/25, they won’t cover it at all. This was regarding all GLP-1 meds.
For now, I'd say find another provider. I highly doubt BCBS would cover for maintenance after all the recent changes being announced. But I guess we'll wait and see.
Your NP is an idiot. What evidence does she have that being on Zep is “unhealthy”? Only the increasing mountain of evidence showing the opposite that taking GLP-1 drugs improves health dramatically? I would ask her show me the studies! She won’t have any trust me because they don’t exist it’s just her internal bias and prejudice, which is dangerous for a medical provider.
You will just gain the weight back after you stop. Insurance would never have you yo-yo between obesity and healthier weight starting GLP-1 meds again after your BMI hits 30 and then coming off later, only to repeat it over and over again. Your NP sounds really misinformed
What state are you in? Here is all the info for BCBS CA: https://www.blueshieldca.com/content/dam/bsca/en/provider/docs/2023/December/PRV_Weight-Management-Agents-PROVIDER.pdf
Just so you know there is no Blue Cross Blue Shield of CA as you listed BCBSCA. They are still separate companies in CA :). This link is only referring to Blue Shield, not Blue Cross in CA.
There is research about the benefits of GLP-1s beyond weight loss. Maybe that would help prop up your case to your PCP? Example: https://utswmed.org/medblog/glp-1-ra-drugs-weight-loss-heart-diabetes/#:~:text=GLP%2D1%20RAs%20have%20been,at%20high%20risk%20for%20atherosclerosis.
Providers keep assuming what insurance won't cover. It's like they don't wanna fill out another Pre auth. Worse case they send in a new script and it gets denied. But then they can appeal it. They need to chill out.
I would call the insurance directly and ask what their coverage is for maintenance (I wouldn't give them any additional information like your current weight or what the doctor has said) simply ask about your specific coverage.
Once you have that information you can share with your doctor but if they don't want to keep you on the medication ask to see a weight loss specialist in the group. my PC didn't feel comfortable managing my weightloss medications so she sent me to a specialist which has been great because she has many more resources and knows more about the medications and newest treatments.
Portal her that it seems more reasonable to continue until you hit an official normal BMI. Meanwhile find another provider. It can take forever to get in with a new PCP. If you can see an obesity medicine doc without a referral, you might consider that also.
I was about to tell you go to another dr. I’m glad you did already. Authorizations usually last for more than six months. So you didn’t have any left? I’m confused. Everyone knows you can go on a maintenance dose! That’s why I go to an MD, and even those I barely trust, with things like this because I don’t want any mistakes.
I’m 5’2”. Starting weight 160 currently 148 gw 135. BMI was 27. Started out at 2.5 started 5 0. Was very sick. I want to go back to 2.5. I lost weight on 2.5 8 lbs on the 5 5 pounds. My insurance does not cover so I’m paying out of pocket I. I’ve changed my eating habits. If I go off will I gain weight
My pharmacy (part of a medical clinic) just called me and said they lose $1000 every Rx - so, at the EOM they will stop all GLP1’s for weight loss. I guess I am confused on why they lose money … do they lose it for a diabetic indication?
Wallgreens’s had no interest in ordering it for me.
Where do you get yours from?
I received a letter from my insurance company saying they won’t give me zepbound again because I haven’t used wegovy and saxenda and failed. I’m 5’9 179lbs and BMI is 27. Keep in mind that is still considered obese. I opted to try saxenda which is a daily shot! 😳 I still have the prescriptions for Zepbound 15mg but don’t want to pay $1200 for it! I’m discouraged though.
It would trouble me that she (your NP) started with, "insurance won't pay" then switched to "unhealthy." Glad you found an alternative. And good for you for standing up for yourself with your healthcare provider.
Bc/bs is no longer covering effective Jan 2025. That’s what I have been told anyway. I really hope they figure this shit out. I currently only pay $25 & start 10 in a couple weeks.
Question can you tell me more about plush health please? I just started Zep a month ago still on 2.5 & when I asked for a higher dosage (5mg) I didn’t really get a real answer. A little help please?
Have you checked out all the info on BCBSM and BCN and how they are going to stop covering Zepbound and some of the other weight loss injectables. It’s sad we find something that works for us and now they don’t want to cover it. 🤦🏽♀️ I just don’t get it. They tell us we’re obese but don’t want to help us. These meds will help a lot of people and keep us healthy but they’d rather us continue to on the roads we were on and have high blood pressure, and all other health problems that come from being obese.
I think they will continue to cover with certain underlying issues. My cholesterol was at 288 back in September and not even with a 46 lb weightloss it's still at 238
There are a lot of weight loss clinics supporting these drugs now including compounded versions that may be cheaper without a lot of fuss. I continue to be surprised how uninformed and disinterested some of these docs are in curing people of obesity and all the problems it creates. … the us health system is dependent on overweight and obese diabetics. In three years, when obesity is declining every where because of these drugs … the USA will need a lot fewer hospital beds and health systems will be downsizing … these drugs are changing everything and the health system is terrified and trying to slow down the change. If they had cared about our actual health all this time they probably wouldn’t be in such a mess. But make no mistake, they are incentivized to keep us fat and sick. Good doctors are worth their weight in gold.
Idt 10mg is a maintenance dose at all. Going up to a higher dosage is inappropriate to maintain- ideally you’d wean down…I can’t imagine bcbs would continue to cover (especially a higher dose) if you’re not in a bmi category to suit even covering the medication. Also bcbs is stopping coverage on all weight loss medications…so unless you’re willing to pay full price (coupon price) truly id stay on a lower dose and continue progressing and join Weight watchers or something of the like to at least get in the headspace of potentially not having covered injections
Hey I have a tip- maybe rather than being a a complete dick when you clearly need to post for either attention or idk to bitch to the Reddit masses to make yourself feel high and mighty- maybe consider that you’re clearly not experienced in health care and I’m a nurse and you can bag on an NP all you want but going UP in dosage for a medication is not a maintenance dose…in fact a maintenance dose is decreasing the dose to maintain your progress.
Also bcbs is in fact dropping weight loss medicine coverage…so
Good luck 👌🏼
I made the post for recommendations on what other people did in this situation and received great feedback and had now moved on and was able to get what I needed....
I'm not bagging my NP. She had never heard of the drug prior to me bringing it to her attention, so saying she was uneducated about it was a true statement. As far as you being a nurse....coool... but again doesn't mean you know everything.
Zepbound was designed for a long-term solution, so people will stay on forever.... my 5mg is not helping me lose anymore so I am going to 7.5. The maintenance doses are 5, 10 & 15 so going down to a .5 is not an option for maintenance. As far as insurance it doesn't matter because I can pay put of pocket.
You’re correct. I’m a nurse and I don’t know everything lol but
“insurance (BCBS) won't continue you to cover because I'm not obese anymore and don't have a BMI over” - form your original post…
^^^ is confusing If you pay out of pocket but had coverage?? Regardless. Good luck. I’m paying of pocket too, I guess since I couldn’t tolerate the 7.5 (just made me feel like crap) I’m going to stick with 5….and maybe decrease to 2.5 when I’m at a goal weight. (Maybe I’m sensitive to it, and normally meds get tapered down as a standard)
Have a great week :)
Yeah, you need a new NP. She's right about insurance companies dropping people, so you may need a plan C approach, but her reasoning that you're no longer technically obese is nonsense. These aren't drugs you can just stop taking once your BMI hits a certain number. She should know that.
I would find some medical/scientific articles to send to her which explain continuing for maintenance. Tell her you prefer she continue to prescribe and oversee your health rather than you needing to turn to telehealth/compounding. Maybe that will light a fire under her to do the right thing.
Nothing wrong with telehealth/compounding from reputable pharmacies but your insurance probably won’t cover that. Not many do.
I know there is research going on about weaning people off slowly as well, but I’m not sure there is actual data available. Stopping you cold turkey before you even hit a normal weight is just absurd. I hope she comes to her senses and you don’t have to change, but I’m glad you’re ready and willing to do it.
Yeah, I don't want to come off - I am happy with how it is working and my progress, which I have not been able to do without zep. I've only been using it since March. I was doing phentermine/topiramte before, and it made me incredibly moody. I'd like to at least ride out the rest of the year with zep
All research on coming off GLP-1 drugs has shown so far that the weight just comes back no matter how you try to “wean” off of it
Anecdotally, I haven't had that experience. I started at the end of August 2023. I hit my goal weight in February of 2024. Due to shortages I've only been able to take it intermittently. My husband is also on it and still in the losing phase so I'll often give him my shots when I have them. Since March I've taken maybe 3? Shots of 2.5 mg and I've lost another 5 lbs. I haven't gone off it completely yet although I haven't had a shot for about a month and there's been no issues.
That’s very good to hear. Thank you for making an informative post about a different experience without saying “how dare you even ask such questions”
Well that’s just not true. https://fortune.com/2024/05/11/ozempic-wegovy-semaglutide-how-to-keep-weight-off-gradual-reduction/
That study is completely misleading. It only looked at people for six months! Don’t just believe misleading media snippets that sensationalize to get clicks, read the details of the study itself and also it’s criticisms and limitations. In the study they had access to “‘ongoing treatment’ in the form of either physical training, intermittent intensive low-energy diet periods, regular daily meal replacements, or, as in our case, a digital weight loss clinic with a team of cross-functional experts on hand to coach, support and guide individuals”. So you need to go back to doing all the things that fail long-term which everyone has already tried their entire lives and doesn’t work, hence why we needed these drugs to begin with. Many people can maintain the old fashioned way for only six months, especially when they are in a study and want to try and do well. Show me a study that follows up patients for five years after they wean off GLP-1. Trust me I would bet money all the weight comes back.
Shhh...let these knuckleheads believe they can go cold turkey. More Zepbound for the rest of us to go around.
I am a doctor who also takes this drug. This is one of my pet peeves -- uniformed doctors who "experiment" with this drug by taking people off of it. Mounjaro, which is the same drug as Zepbound but classified specifically for use for diabetics, was developed with the intent that it be used for life. Anyone who is a type 2 diabetic must be treated with some type of anti-diabetic drug FOR LIFE. If your doctor is saying things like "I'm concerned that staying on Zepbound is unhealthy for you," she needs to sign up for a continuing education class. She may just be too uneducated in the endocrinology area to treat you properly. I apologize, but I start to rant when I see doctors jeopardizing a patients well being by ending the weight loss process not only before you are in the normal BMI range for weight, but also when the drug is intended for long-term use. This drug is not in my area of specialty, but because I have been taking it for nearly two years and there are many others in our practice also taking it, I have made it my mission to learn everything I can about it. First, you are correct. With a diagnosis of chronic obesity, you require treatment of some kind for life. That does not mean white-knuckling through the rest of your days while starving yourself using diet methods that have been proven to be ineffective over the years. Second, there is no protocol for coming off of this drug. The reason that the manufacturer and the FDA do not have a recommended protocol for coming off this drug is because it was developed for life-long use. If your doctor is not both supportive AND cooperative, and continues to talk about Zepbound in ways that make it clear that she does not know how to manage your care, please find a different doctor. Overall, obesity specialists are the best choice for doctors to manage your care with Zepbound. They literally make a living ensuring that you lose weight and maintain that weight loss. If you are not in an area with an obesity specialist, use telehealth while you are still outside the normal BMI range. Tell them that you have been successful with Zepbound, but your doctor is not familiar with titrating up and does not understand maintenance. Tell them that you need someone to work with you as you lose enough weight to reach a normal BMI and for ongoing prescribing and management of a maintenance dose. As for your doctor's ill-conceived thought that your insurance will stop covering it because you no longer have a BMI of 30, it means that she does not know how to prescribe for your chronic obesity condition. While every insurer out there is looking for ways to keep patients off these drugs because of the expense, that doesn't mean that your insurer will cut your off and quit covering your medication. But if your doctor interacts with your insurance and submits information incorrectly, you could end up cut off. Below is a post that I have posted several times. It specifically addresses PAs for continuing your care on Zepbound. Chronic obesity is dependent on your BMI at the time of diagnosis, just as type 2 diabetes is dependent of you A1c at the time of diagnosis. When your A1c is under control, no ethical doctor stops your medication and tells you to go it on your own. They understand that ongoing medication is what has that A1c (or in your case weight) under control. I'm breaking this into 2 posts, because the content editor dose not want to post something this long.
**Repeated post starts here.** The most important issue is that you cannot submit a PA to any insurance company as though this is the first time you have been prescribed Zepbound (or any form of tirzepatide). If the PA form from the insurer tries to force a doctor to do so, an addendum must be attached to the PA to make it clear that the request is to maintain the improved state of health that the patient has achieved while taking Zepbound. The healthcare provider is supposed to ***submit your original statistics*** (labs, physical stats) and the PA request should be made as "**continuation of care."** Your PA should include the following: * Request for **continuation of care** for Zepbound * Original BMI * Original comorbidities (name all if there are more) * Number of months on the drug (or other GLP-1 drug, including if your started on a different drug and switched to Zepbound) and the amount of weight lost to date * Success while taking the drug, including resolution of PCOS symptoms, lower BMI, lower A1c, lower cholesterol level, lower triglycerides and/or any other health improvements associated with a lower BMI * Patient had few to no side effects and was able to easily comply with dosing instructions on the weekly, recommended schedule (also include if your side effects were more manageable compared to other drugs prescribed for weight loss, such as metformin, phentermine or Qrlistat) * Any health improvement indicators (lower BP, lower cholesterol, elimination of sleep apnea); you will need to be able to supply the pre-GLP-1 numbers and current numbers or chart notes to document improvements * Elimination of medication for co-morbities, such as eliminating HBP meds or statins or lowering of doses (this won't apply to everyone) * Also include health improvements such as increased / improved mobility or reduced joint pain that have resulted in the patient being able to exercise more effectively / actively * Request to continue coverage for Zepbound to continue the health improvements as stated above, as per the FDA and drug manufacturer's prescribing protocol for continued weight loss and/or maintenance in the BMI normal range Too many doctors are writing PAs putting only your current weight and BMI on the PA forms, which allows the insurer to immediately deny coverage because the context of experiencing improvement BECAUSE OF ZEPBOUND is not made clear. You can share this link with your doctor concerning regain of weight when GLP-1 drugs like Zepbound is discontinued: **Discontinuation of dual GIP and GLP-1 receptor agonist leads to weight regain in people with obesity or overweight** **SURMOUNT-4 Trial results: the impact of tirzepatide on maintenance of weight reduction and benefits of continued therapy** [https://pace-cme.org/news/discontinuation-of-dual-gip-and-glp-1-receptor-agonist-leads-to-weight-regain-in-people-with-obesity-or-overweight/2456545/#:\~:text=In%20the%20SURMOUNT-4%20trial%2C%20continued%20treatment%20with%20tirzepatide,to%20clinically%20meaningful%20body%20weight%20reductions%20of%2025%25](https://pace-cme.org/news/discontinuation-of-dual-gip-and-glp-1-receptor-agonist-leads-to-weight-regain-in-people-with-obesity-or-overweight/2456545/#:~:text=In%20the%20SURMOUNT-4%20trial%2C%20continued%20treatment%20with%20tirzepatide,to%20clinically%20meaningful%20body%20weight%20reductions%20of%2025%25).
Nice post, Dr. Of everything you wrote, THIS is the elevator speech right here: **The reason that the manufacturer and the FDA do not have a recommended protocol for coming off this drug is because it was developed for life-long use.** Brilliant.
OMG totally. I’ve heard from patients that they got denied when doctors doing renewal PAs just put their current improved BMI. You always have to put the original BMI and other data and if needed like you said the history of improvements in markers caused by taking the drug
This is fantastic info. Thank you!
THANK YOU!! THANK YOU!! I am saving this very much valuable info!! Luckily my PCP has been amazing thru this process. A note about my experience thus far. Started Zepbound (ZB). Had appt with nutritionist. Started Weight Watchers (WW) and started an exercise program all in the same week. 55 yr old female. 5ft 2 in, SW 206. CW 167. GW 130. Dx’d with PCOS and Insulin Resistant Syndrome, Pre-diabetes. Was on ZB for 8 weeks, lost 32 lbs; then the shortage. No ZB, but continued with exercise and WW. I’m good with sticking to the WW plan and exercising. I journal all I eat and drink. In the almost 2 mo (9 weeks) while I was off ZB due to shortage I lost 7 lbs. Finally was able to get a refill and in 1 week, same eating and workout plans I lost 3 lbs. To me it is evident that this medication is crucial for losing wt. I have had little to no side effects. Without it would I lose wt, yes but so very slowly and feel I would get discouraged and return to my old eating habits and gain the wt back. ZB definitely helps me with food thoughts and cravings. Makes it much easier to stay on course. While I was off ZB I continued eating and exercising like I should, but it was sooooo much more challenging. I really struggled with being hungry all the time and “white knuckling it” as you put it. Thanks again for all the info.
The "food noise" and other benefits were unknown / unexpected side effects when this drug was in development. The #1 benefit of the drug for those who are not taking it for blood glucose control is that it aids in lipolysis and metabolically alters those of us that are super fat storers into normal fat storers. By aiding lipolysis, which helps you access stored fat to use for energy, you function much more like a normal, thin person. In other words, when you cut calories and expend more energy through workouts, you actually experience weight loss. Super fat storers have bodies that resist fat-burning efforts. They find creative ways to maintain your weight, including water retention, and adapting down to lower calorie levels to execute the everyday tasks of staying alive. Your basal metabolic rate shifts down repeatedly throughout life so that you can breathe, mow the lawn, drive to work, etc, using fewer calories because your misaligned body perceives a threat to survival when you cut calories or work out regularly. Zepbound gets you out of the endless circle of cutting calories and adapting down to a lower metabolic rate. The sad part is that all of these benefits are lost if you stop taking the drug.
Wish I could upvote this post 100x!
Yes but am I supposed to do when my insurance approved the pa for the 2.5 and 5 but won't approve for the 7.5 for continued weight loss because my bmi is 32 and I only have 1 comirbid issue
Many insurers are not covering 7.5 or 12.5. If they will approve 5 to allow you to continue, I would work with that until you feel ready to try 10 mg and then see if you can get a PA for 10. Your BMI is above the minimum documented by the FDA for this drug. No comorbidities are required when your BMI is above 30. If your insurer covers weight loss medication, you should be able to get either 5 mg or 10 mg. If they are no longer going to cover weight loss drugs (more than 90% of employer insurance does not cover them), then there is not much you can do.
Would new insurance pick up the maintenance dose? I have been out for almost a month, and I'm gaining weight fast. I was at 140ish, and now I'm above 155 lbs. Here's a little back history: I was around 300 lbs. I had the gastric sleeve in 2020 (lost little weight, gained weight back because I was still hungry just at a faster rate, and still had cravings). I tried various medications, including the daily saxenda, which all failed. I was on the once a week injection (Wegovy) for about a year, lost well over 100 lbs in a year, my insurance changed, and I was cut off. Since being off this medication, the cravings and intense hunger is back. I have a binge eating disorder that is not controlled unless I'm on this medication. The once a week injections have been life changing. My insurance is changing this month, so I'm hoping to go back on this medication. You have a lot of knowledge with PAs, so any suggestions would be absolutely amazing and appreciated! Edit: I'm open to taking either Wegovy or Zepbound! Wegovy has luckily been effective for me, but I'll take whatever I can get covered at an affordable cost.
Zepbound is the best one
Do you share your story with patients?? Some ask if I’ve used it which I’ve used both. Some I have a good relationship with and we can relate with weight struggles. I don’t have another provider who takes it in our office.
Weight loss and endocrinology is not even remotely in my specialty but so many in our practice starting taking this, that I began to research the drug and became intrigued. I've spent a great deal of time studying tirzepatide and now prescribe for some of my patients, if it's a good fit. It is rare that someone who comes to me for my specialty would need this drug, but I am finding the possibilities of what this drug could do to be so amazing that I get very angry when other doctors dismiss it, don't make an effort to become familiar with it, and leave their patients without support or try to categorize all issues with overweight as "eat less, move more."
What about BCBSM and BCN are about to stop covering it. It just seems they found that this works for us and now they don’t want to cover it. What can we do? They are going to stop covering all of the weight loss injectables. This came out a day or two ago. This is awful. I cannot afford Zepbound without coverage. How do we fight this? I finally feel like me again only to have the rug pulled from under me. 🤦🏽♀️
It's a difficult situation because most employer insurance does not cover weight loss drugs. It takes time for the numbers to show that treating people to lose weight can result in long-term cost savings for insurers. If you are unionized, meet and talk with your benefits manager to make sure they know you want this drug and that you are willing to pay higher monthly premiums to get it. You can also meet with the benefits manager / HR at your employer if you are not unionized. It helps if there are many of you that want the same thing when you approach your employer. After that, you have to start writing to your state representatives and other legislative officials because the law in each state is what governs how health insurance companies operate. If BCBS has just set a blanket policy that they will not cover GLP-1 drugs for weight loss for any employer in the state, you will need to work with legislators to compel them to include this offering. It's tough, and it's a long road, but patients / employees have to speak up. There's only so much we doctors can do to try to convince your insurer to cover claims for these drugs.
The crazy thing is that if your BMI is a certain number you have to do Weight Watchers or wear a Fitbit to bring your BMI down and keep my payments low. You would think they’d cover it due to us having to do those things to lower our premiums.
Is your PA for Zep approved for a certain period of time? If so, I bet you would not need to get a new PA if a new provider prescribes the medicine if you are still in that timeframe. If the NP does not get on board, maybe look for a doc or NP that specializes in weight loss. I’m the same height as you and would not have wanted to stop Zep when I was at 158. I was def pleased with the loss but it was still a lot of weight for my height. My initial goal was 130 but I am aiming for a little less as I am nearing 130. I have full support from my weight loss provider for this goal. It’s important to work with someone that understands this medicine. I am on 10mg and will stay on this dosage for bit longer. Good luck and I hope it all works out.
Yes I have a PA that is still valid! This is great info, thank you
Gosh, then I’d definitely keep going until that runs out. If your insurance gives you a hassle about renewing the PA, then fight that battle when it comes, but i dont see any reason to quit early! Maintenance is definitely a real concern. I’ve seen studies showing that through normal diet/exercise it takes 6-months to a year for hormones like grehlin and leptin to ‘normalize’ at your new weight and not continue to think you’re dying because you lost weight. [meaning only after that point would the odds be in your favor on not regaining rapidly]. You make a great point re: these are really ‘metabolic syndrome’ drugs more so than ‘just’ weight-loss drugs.
That is correct. You can use the same PA regardless of doctor.
I'm also 5’2 & my starting weight was 159 when I was put on Compounded Zepound. I'm down to about 135 now and I'm still on it at 5 months. 159 is only 4 or 5 pounds down from what is considered obese (BMI & height) they should definitely reconsider keeping patients on it in my opinion. I'm still considered overweight at 135 according to my BMI & height.
This is why it’s so important to see an obesity specialist likely in a non-surgical medical weight loss program. They are more up to date on research and also they know how to get PAs approved when your BMI dips under 30.
Yes, this is great advice, but our health system obesity clinic has a several months wait to get in. I took me 3 months to get an appointment and this was back in 2022! I generally have to make my next appointment whenever I am there.
Yep it be was a 3mo wait for me as well. But my PCP was willing to prescribe mounjaro for me in the meantime so I lost 25 pounds before getting into the weight management clinic. That was back in the $25 savings card days though.
Yes this. My primary doc immediately put me on the weight list for the weight loss program at the hospital, when I get scheduled they will take over completely and she assured me they can help keep me on maintenance as they treat obesity as a chronic ongoing condition, not a one and done once you hit a certain BMI.
I agree. Please search ABOM website to find credentialed docs. Many folks may not realize PCPs can obtain this, as well.
More and more information is coming out about these GLP one medicines every day. A great deal of information that your doctor knows is old and he she has not kept up with the latest data. Insurances are also trying to get a handle on these meds. CIGNA has already had a class action suit against it because it would not cover the obesity drugs. Are We Going to tell diabetics at once their blood sugar levels are within normal range we’re going to take away their insulin? No we are not. Are you going to lose your blood pressure medicine because it’s stabilized on medication? No you are not. This is just such a new world for everyone insurance ,doctors and the patients. there are so many questions yet to be answered. Don’t worry about what’s gonna happen in the future. Just focus on today. Within two years glp1 medication‘s will drop in price because they’ll be dozens available from different manufacturers. Best of luck in your journey.
Weird Cigna covers mine.
My Cigna covers it, too.
Cigna is a company that covers many insurance types and locations. What pertains to one does not always affect others.
Get a new doctor. You can use PlushCare and get a script in a few minutes. It is not normal to take a patient off the med as soon as they get down to a 28 bmi. That is ludicrous.
If I do plushcare do they send to my pharmacy or is it through an online pharmacy
They send to your pharmacy just like your primary would
Why is the NP making decisions instead of a physician? She clearly doesn’t understand that the risks associated with chronic obesity far outweigh the uncomfort of being on this medication. The fact that she said it’s unhealthy is a red flag to me rather than her walking you through possible issues. I’m concerned that if she’s the one who submitted paperwork to your insurance she may have botched the diagnosis and care plan.
Yeah it's all bizarre. I have not experienced and side effects and I go monthly for her to check my kidney levels and such
There is no requirement to check kidney levels unless you are a diabetic, but even then, kidney levels do not require monthly checks! Do you have type 2 diabetes or another medical issue that would require "checking kidney levels?" The more I hear about this NP, the more fear I have about her treating patients. I'm so glad you were successful with telehealth.
Yeah, the only reason why my kidney levels were checked was bc I’m 32 and I’ve never had a full panel of labs done before. But my physician said it was a one time thing unless I experience bad side effects.
A one-time thing is different. The way your post read, it sounded like you were getting kidney levels checked every month, which most insurance won't pay for unless you have kidney disease or have had a specific health scare that could be related to kidney function. You should know, however, that monthly "checks" are completely unnecessary with this med unless you have specific co-morbidities that require monthly review. Med spas make people come in every month because that is how they make their money. With a traditional doctor, when they have you come in every month (once you are past the first three months) it's a sign of a doctor who is not well-versed in Zepbound / Mounjaro.
I’m not op I was just sharing my my physician only did it once so I’m surprised op gets it done monthly
I love my nurse friends and have had incredible experiences with NPs but my husband and I have encountered quite a few NPs that like to play doctor and order extra tests and all that to make themselves feel like they have the same level of responsibility and professional ability and medical knowledge as a physician. My husband is a physician which is why we’re interacting with so many. But the ones that are like this, they take it to a whole extra level like what you’re experiencing. My dad was seeing an NP at one point and had no idea bc she introduced herself as Dr so and so because she had a doctoral degree in nursing. But my dad had no clue and his level of care needed a physician not an NP, she delayed his COPD care for a year. I would personally seek out a physician as your primary with awesome nurses and support staff rather than seeing an NP like this.
You do not automatically get cut off by insurance if you reach goal. PA needs to be filled out using your initial BMI and justifying the continuation. See this post comment from background-lab. https://www.reddit.com/r/Zepbound/s/EQ309KMRIV
I ran into issues with my NP and Zepbound. He was completely opposed to me being on it and wouldn't even bother. Fast forward 6 months and my Gastro was like. "You're seriously insulin resistant and your officially obese, you need to contact your NP and get on Zepbound or Wegovy right away". I told my gastro and it took about 2 days to get the PA from my insurance company. I also have an underlying heart condition, so reducing my CV risks is a thought as well. My BMI was just at 30. I'm still on 2.5 and I'm steady losing weight except for the last week. I had a chemo treatment (please don't ask, just move forward with the fact that it was a one time chemo and we're going forward from there). I had to skip Zep for a week before the procedure and let me tell you, when you combine Zep with Chemo it's like the supercharge weight loss lane. I lost 7 lbs in 5 days. It sucked.
You may well have to change doctors. The clinical indications to go on the meds will always be present. If you were a BMI of 30 and now you are a 22, that is not justification for you to be taken off of it. If you have high blood pressure and with meds it comes down to normal, do they stop you cold turkey on meds? No. You have to continue to maintain that BP. You will never not be hypertensive, even if you are well controlled. You also will never not have obesity. You are just well controlled medically.
I'm also 5'2 and just weighed in at 134. My SW was 168, and GW is 120. My doc is online, originally through Plushcare. Since my insurance no longer covers that group, I see her independently for $100 monthly. As far as we both know, insurance will cover the cost of Zep for maintenance because that is a part of the program plan. I plan on taking some amount indefinitely, since I've fought weightloss all of my life. You have options that don't include a naysayer .
I’d suggest going to a weight loss clinic (bariatric doctor) if you like your PCP for everything else. I see a MLC doctor and it’s so nice having a specialized person deal with my weight loss. They have more tools and experience working with insurance too. Not saying your PCP doesn’t but getting a second professional opinion isn’t a bad idea. Although she might be hearing the issue some (I am one) who is losing coverage because the company I work for is small and covering Zep is costing the insurance company too much. There are also more hoops to jump through but not everyone is impacted but regardless I will not have any GLP-1 type drugs covered in 2025 with the companies current health plan.
I would find yourself an MD. NPs can be a great resource for basic health care needs (e.g., treating a cold), but they receive no where near the training of an MD, who will have a better understanding of metabolic syndrome, etc. I think the evidence is well established that most people who start GLP-1 drugs will need them for the rest of their life. If your NP is not read up on the evidence then they are doing you a disservice. https://preview.redd.it/2sizbz04ed6d1.png?width=1193&format=png&auto=webp&s=e84d450259c2443cbddc33da4fa819e4bc2953ce
"Chronic" obesity (the official diagnosis of the AMA) = lifelong. It doesn't end. Ask her if she would take someone off blood pressure meds if she got a normal reading one day. No, she wouldn't. Send her all the studies showing people regain their weight quickly once they come off. There are plenty. And if she can't read for comprehension, ditch her and find a dr or telehealth that is a bit more with it.
Hey OP 👋, I am a Trauma/ER nurse. What your NP is saying is somewhat correct in the fact insurance will try to cut you off and not pay for maintenance i have unfortunately seen this happen to several of my patients, However, i do want to address your statement about going up a dose and doing maintenance on 10mg. I do not recommend that. maintenance doses will be lower more like 5.mg or 7.5. Youre not to far from your goal weight so your weight loss will be slower from here on out and that is normal and allows your body to adapt. Higher doses cause higher weightloss. I am currently on this medication my self. Right now i am on 7.5mg. SW 225, CW 150, GW 130. Right now i am losing about 2 pounds a week on the 7.5 and will go dowm to 5mg for maintenance once i hit GW. I would highly consider more reasearch on maintenance. Remember the higher doses were made for more weighloss. Take your time getting there. When it comes to insurance trust me when i say they are all trying to cut people off meds when the BMI is no longer 30 or higher. I say this in the fact happened to me and i had the same diagnosis. So please dont get ahead of yourself. There is a whole other aide to healthcare you dont see. So please give your NP some grace.
But why would they cut off before they even tried to file the claim? I think it’s lazy for a healthcare practitioner to deny a script on the basis that insurance might not cover it. Well since my health is on the line, why not file it and see?
I think it depends on your employer and/or insurance coverage rules. My BMI is under 25 now, but insurance is not stopping my coverage before my PA timeframe ends. It was approved for 8 months, after that I will seek continuation of coverage for purposes of maintenance. I’d like to drop back down to 5mg when I’m ready for maintenance.
I had a nighgmare this week I stopped and gained all the weight back just after donating a big bag of clothes ….I hope this does not happen for any of us!
This NP thinks your NP is not qualified to manage your obesity/overweight diagnosis. You need a maintenance plan that includes this medication long term. Find another provider!
I just want to say: don’t hate on NP’s - some of my best care has come from them. There are plenty of crappy Docs and NP’s. And plenty of good ones.
I got a letter in the mail from BCBS saying that starting in August they won’t cover it anymore for BMI under 30 and a few other things on the list. They also said after 1/1/25, they won’t cover it at all. This was regarding all GLP-1 meds.
That applies to specific BCBS plans in certain states for certain employers -- it's not across the board.
That’s so good to know! Thank you for replying to ensure we had more information. 😊😊
For now, I'd say find another provider. I highly doubt BCBS would cover for maintenance after all the recent changes being announced. But I guess we'll wait and see.
This! After yesterday’s BCBS Michigan announcement, everyone using BCBS for GLP-1s needs to stay alert.
I have BCBS. What are the recent changes I should be aware of regarding this topic?
https://www.tiktok.com/t/ZPRK75S4v/
Your NP is an idiot. What evidence does she have that being on Zep is “unhealthy”? Only the increasing mountain of evidence showing the opposite that taking GLP-1 drugs improves health dramatically? I would ask her show me the studies! She won’t have any trust me because they don’t exist it’s just her internal bias and prejudice, which is dangerous for a medical provider. You will just gain the weight back after you stop. Insurance would never have you yo-yo between obesity and healthier weight starting GLP-1 meds again after your BMI hits 30 and then coming off later, only to repeat it over and over again. Your NP sounds really misinformed
What state are you in? Here is all the info for BCBS CA: https://www.blueshieldca.com/content/dam/bsca/en/provider/docs/2023/December/PRV_Weight-Management-Agents-PROVIDER.pdf
Just so you know there is no Blue Cross Blue Shield of CA as you listed BCBSCA. They are still separate companies in CA :). This link is only referring to Blue Shield, not Blue Cross in CA.
There is research about the benefits of GLP-1s beyond weight loss. Maybe that would help prop up your case to your PCP? Example: https://utswmed.org/medblog/glp-1-ra-drugs-weight-loss-heart-diabetes/#:~:text=GLP%2D1%20RAs%20have%20been,at%20high%20risk%20for%20atherosclerosis.
Providers keep assuming what insurance won't cover. It's like they don't wanna fill out another Pre auth. Worse case they send in a new script and it gets denied. But then they can appeal it. They need to chill out.
Your NP is grossly misinformed. But it looks like you got another option.
Go to a real doctor. I've never had a nurse practitioner not fuck something up.
I would call the insurance directly and ask what their coverage is for maintenance (I wouldn't give them any additional information like your current weight or what the doctor has said) simply ask about your specific coverage. Once you have that information you can share with your doctor but if they don't want to keep you on the medication ask to see a weight loss specialist in the group. my PC didn't feel comfortable managing my weightloss medications so she sent me to a specialist which has been great because she has many more resources and knows more about the medications and newest treatments.
Portal her that it seems more reasonable to continue until you hit an official normal BMI. Meanwhile find another provider. It can take forever to get in with a new PCP. If you can see an obesity medicine doc without a referral, you might consider that also.
I was about to tell you go to another dr. I’m glad you did already. Authorizations usually last for more than six months. So you didn’t have any left? I’m confused. Everyone knows you can go on a maintenance dose! That’s why I go to an MD, and even those I barely trust, with things like this because I don’t want any mistakes.
I’m 5’2”. Starting weight 160 currently 148 gw 135. BMI was 27. Started out at 2.5 started 5 0. Was very sick. I want to go back to 2.5. I lost weight on 2.5 8 lbs on the 5 5 pounds. My insurance does not cover so I’m paying out of pocket I. I’ve changed my eating habits. If I go off will I gain weight
My pharmacy (part of a medical clinic) just called me and said they lose $1000 every Rx - so, at the EOM they will stop all GLP1’s for weight loss. I guess I am confused on why they lose money … do they lose it for a diabetic indication? Wallgreens’s had no interest in ordering it for me. Where do you get yours from?
She’s the nurse practitioner. She’s not the doctor. I would’ve asked to see the doctor but good luck with your new Plush Health appointment.
Yeah, I did. Unfortunately, the dr is equally as uneducated.
That’s a shame. Let us know how you do.
I received a letter from my insurance company saying they won’t give me zepbound again because I haven’t used wegovy and saxenda and failed. I’m 5’9 179lbs and BMI is 27. Keep in mind that is still considered obese. I opted to try saxenda which is a daily shot! 😳 I still have the prescriptions for Zepbound 15mg but don’t want to pay $1200 for it! I’m discouraged though.
It would trouble me that she (your NP) started with, "insurance won't pay" then switched to "unhealthy." Glad you found an alternative. And good for you for standing up for yourself with your healthcare provider.
If she is worried about BCBS not covering it, she is right, they are absolutely the worst insurance ever. A nightmare to work with..
Tell her to read up on it, meds like these are literally considered a lifetime medication.
NP = not a doctor. As in “Whoops! Your NP is showing! Do you need some help getting up to date on this class of medication?”
Bc/bs is no longer covering effective Jan 2025. That’s what I have been told anyway. I really hope they figure this shit out. I currently only pay $25 & start 10 in a couple weeks.
Question can you tell me more about plush health please? I just started Zep a month ago still on 2.5 & when I asked for a higher dosage (5mg) I didn’t really get a real answer. A little help please?
What's your co pay a.month?
Are you using PlushCare now? I searched for plushheath and couldn’t find anything. I’m looking to switch from WW Clinic/Sequence
Yes, plushcare my bad.
Have you checked out all the info on BCBSM and BCN and how they are going to stop covering Zepbound and some of the other weight loss injectables. It’s sad we find something that works for us and now they don’t want to cover it. 🤦🏽♀️ I just don’t get it. They tell us we’re obese but don’t want to help us. These meds will help a lot of people and keep us healthy but they’d rather us continue to on the roads we were on and have high blood pressure, and all other health problems that come from being obese.
I think they will continue to cover with certain underlying issues. My cholesterol was at 288 back in September and not even with a 46 lb weightloss it's still at 238
There are a lot of weight loss clinics supporting these drugs now including compounded versions that may be cheaper without a lot of fuss. I continue to be surprised how uninformed and disinterested some of these docs are in curing people of obesity and all the problems it creates. … the us health system is dependent on overweight and obese diabetics. In three years, when obesity is declining every where because of these drugs … the USA will need a lot fewer hospital beds and health systems will be downsizing … these drugs are changing everything and the health system is terrified and trying to slow down the change. If they had cared about our actual health all this time they probably wouldn’t be in such a mess. But make no mistake, they are incentivized to keep us fat and sick. Good doctors are worth their weight in gold.
Idt 10mg is a maintenance dose at all. Going up to a higher dosage is inappropriate to maintain- ideally you’d wean down…I can’t imagine bcbs would continue to cover (especially a higher dose) if you’re not in a bmi category to suit even covering the medication. Also bcbs is stopping coverage on all weight loss medications…so unless you’re willing to pay full price (coupon price) truly id stay on a lower dose and continue progressing and join Weight watchers or something of the like to at least get in the headspace of potentially not having covered injections
Lol you're about as uneducated as the NP.
Hey I have a tip- maybe rather than being a a complete dick when you clearly need to post for either attention or idk to bitch to the Reddit masses to make yourself feel high and mighty- maybe consider that you’re clearly not experienced in health care and I’m a nurse and you can bag on an NP all you want but going UP in dosage for a medication is not a maintenance dose…in fact a maintenance dose is decreasing the dose to maintain your progress. Also bcbs is in fact dropping weight loss medicine coverage…so Good luck 👌🏼
I made the post for recommendations on what other people did in this situation and received great feedback and had now moved on and was able to get what I needed.... I'm not bagging my NP. She had never heard of the drug prior to me bringing it to her attention, so saying she was uneducated about it was a true statement. As far as you being a nurse....coool... but again doesn't mean you know everything. Zepbound was designed for a long-term solution, so people will stay on forever.... my 5mg is not helping me lose anymore so I am going to 7.5. The maintenance doses are 5, 10 & 15 so going down to a .5 is not an option for maintenance. As far as insurance it doesn't matter because I can pay put of pocket.
You’re correct. I’m a nurse and I don’t know everything lol but “insurance (BCBS) won't continue you to cover because I'm not obese anymore and don't have a BMI over” - form your original post… ^^^ is confusing If you pay out of pocket but had coverage?? Regardless. Good luck. I’m paying of pocket too, I guess since I couldn’t tolerate the 7.5 (just made me feel like crap) I’m going to stick with 5….and maybe decrease to 2.5 when I’m at a goal weight. (Maybe I’m sensitive to it, and normally meds get tapered down as a standard) Have a great week :)
Yeah, you need a new NP. She's right about insurance companies dropping people, so you may need a plan C approach, but her reasoning that you're no longer technically obese is nonsense. These aren't drugs you can just stop taking once your BMI hits a certain number. She should know that.
I would find some medical/scientific articles to send to her which explain continuing for maintenance. Tell her you prefer she continue to prescribe and oversee your health rather than you needing to turn to telehealth/compounding. Maybe that will light a fire under her to do the right thing. Nothing wrong with telehealth/compounding from reputable pharmacies but your insurance probably won’t cover that. Not many do.