Has anyone had any luck getting insurance coverage of Mounjaro or Wegovy for weight loss only?

[KidsHappen]

I talked to my doctor today and he said that he is been writing many prescriptions for this for weight loss but almost nobody's insurance covers it and it cost between $1000-$1700 with GoodRx. I do see that they both have savings cards that we will apply for. Has anyone had any luck with that?

If you are using it for weight loss, how long does it take to lose say 10% and will you regain the weight after stopping the meds?

[Pawz4me]

I don't have any personal experience, but everything I've read says that once the medications are discontinued almost everyone regains the lost weight.

[KidsHappen]

14 minutes ago, Pawz4me said:

I don't have any personal experience, but everything I've read says that once the medications are discontinued almost everyone regains the lost weight.

Well that is frustrating. The weight gain is almost certainly due to my bipolar meds which I can't give up. We determined that my diet is good. I am eating the correct amount of calories. I am already fasting 12-16 hours a day. I can't increase exercise due to health issues. We have already tried other medications that did work but had unacceptable side effects. This was sort of a last ditch effort. But they are so hard to get and cost so much money that I don't know if it would be worth the effort if it didn't produce lasting change. 

[BeachGal]

Berberine has a similar effect but you’d want to research it. I don’t know much about side effects but a lot of people have been taking it for weight loss.

[Mrs Tiggywinkle Again]

I was on Ozempic and then was unable to get it for two months due to supply issues. I’d lost 80 pounds and gained back almost 30 in the 2 months I was off. All the research shows that people gain the weight back if they ever go off the drugs.  It’s a lifelong medication.

Insurance companies know this and are much more interested in paying for cheaper weight loss methods.

[DawnM]

Some people have had success with their doctors writing pre-authorizations and then using the discount card, although I am not sure if the discount card is valid right now and I can tell you that everything I am reading says that the starter doses of .25 and .5 and even somewhat the 1.0 dosages are not going to be in stock until September or even October.

There are ways around this, but most doctors won't approve it (youtube "wegovy dosage adjust to find out how using diabetic supplies).  

My insurance covers it but many don't cover it for weight loss.   I was paying $25/mo although this last one was $30.   But that is peanuts compared to retail cost.

As far as weight loss, everyone is different.   Some don't lose on the lower two doses and I would be really upset if I paid $3,000 for medication that didn't work for the first two months.   However, many who get through that say they drop weight like crazy on the 1.0 and above dosages.

I started taking it in March and then took it for March and April and lost 16 pounds.  It has literally been the only thing that has helped.   I have tried everything.    I couldn't find it for the month of May.   I have finally found some 1.0 but I am scared to try it after no meds for 4 weeks, so I am going to do the Youtube method and go back to a smaller dose and build up.   I have been working with my friends who are in the medical field to verify how to do it and to do it correctly.  

If there is any way to get a doctor to give you a higher dosage and you would be ok with splitting it yourself, you could potentially get several months out of the 1 month supply, but I don't think any doctor will prescribe that higher dosage without building up.

Edited June 1, 2023 by DawnM

[Brittany1116]

3 hours ago, KidsHappen said:

Well that is frustrating. The weight gain is almost certainly due to my bipolar meds which I can't give up. We determined that my diet is good. I am eating the correct amount of calories. I am already fasting 12-16 hours a day. I can't increase exercise due to health issues. We have already tried other medications that did work but had unacceptable side effects. This was sort of a last ditch effort. But they are so hard to get and cost so much money that I don't know if it would be worth the effort if it didn't produce lasting change. 

Just a thought on the fasting side... most people are seeing weight loss with IF at or just past the 16 hour mark. If you can consistently get to 16-18 hours, you might see a payoff. 17 is definitely my sweet spot.

[Halftime Hope]

@KidsHappen Definitely research berberine and give that a try. It has so much good research, and it's not harmful.

I have a two family members who are on Mounjaro and on Wegovy. It is not helpful in the long run. For the young one on it, I don't know what the %^&* his doctor was doing, putting him on it. He's young, capable of being fit, has no other health concerns other than being overweight, and should tackle this problem with lifestyle changes. It makes me so angry that he is not getting wellness care. 

 

[Wheres Toto]

What are good, reliable brands for berberine.  Available from Amazon would be a plus. 

[Grace Hopper]

10 minutes ago, Wheres Toto said:

What are good, reliable brands for berberine.  Available from Amazon would be a plus. 

Klaire Labs Berberine HCI 500mg - Berberine Supplement - Gluten-Free, Hypoallergenic Berberine Supplement (120 Capsules) https://a.co/d/9O5WcFL

https://www.healthline.com/nutrition/berberine-powerful-supplement#what-it-is

(second link posted is for info only; I have no experience with brands other than the Klaire Labs brand in the first link which is the one recommended by my doctor)

Edited June 1, 2023 by Grace Hopper

[Myra]

3 hours ago, Mrs Tiggywinkle Again said:

I was on Ozempic and then was unable to get it for two months due to supply issues. I’d lost 80 pounds and gained back almost 30 in the 2 months I was off. All the research shows that people gain the weight back if they ever go off the drugs.  It’s a lifelong medication.

Insurance companies know this and are much more interested in paying for cheaper weight loss methods.

 

I am confused about why people gain the weight back when/if they go off the drug.  

I mean, if Ozempic helps a person lose weight then why the going off the drug necessitates that the weight will be gained back?

 

 

[Mrs Tiggywinkle Again]

11 minutes ago, Myra said:

 

I am confused about why people gain the weight back when/if they go off the drug.  

I mean, if Ozempic helps a person lose weight then why the going off the drug necessitates that the weight will be gained back?

 

 

GLP1 agonists work for weight loss essentially by killing hunger.  For diabetics it lowers glucose as well by mimicking a hormone called GLP-1.  It also stops the liver from making glucose.Your stomach empties slower so you feel full quicker and longer.  For many people it seems to have some anti addictive qualities especially for things like binge eating or food addiction.  The higher doses seem to quell the food noise in their heads.

But when you stop taking it, it goes away and people feel hungry again.

Edited June 1, 2023 by Mrs Tiggywinkle Again

[Grace Hopper]

3 minutes ago, Myra said:

 

I am confused about why people gain the weight back when/if they go off the drug.  

I mean, if Ozempic helps a person lose weight then why the going off the drug necessitates that the weight will be gained back?

 

 

Because what it seems to affect mainly is satisfaction signals, rather than “melting off the fat.”  People eat less because they don’t feel hungry , therefore they lose weight. 
 

https://www.reuters.com/business/healthcare-pharmaceuticals/novo-nordisk-says-stopping-obesity-drug-may-cause-full-weight-regain-5-years-2023-03-30/#:~:text=Drug %26 Device Trials-,Novo Nordisk says stopping obesity drug may,weight regain in 5 years&text=March 29 (Reuters) - Patients,CO) official said on Wednesday.

Once people stop taking the meds, they begin to feel hungry again and start eating like they did before taking the meds. It’s more complicated than that but it’s basically what happens. 

On the bright side, there are hopes these meds might eventually be helpful in other ways:

https://amp.cnn.com/cnn/2023/06/01/health/weight-loss-drugs-addictive-behaviors/index.html
 

 

[Grace Hopper]

1 minute ago, Mrs Tiggywinkle Again said:

GLP1 agonists work essentially by killing hunger.  Your stomach empties slower so you feel full quicker and longer.  For many people it seems to have some anti addictive qualities especially for things like binge eating or food addiction.  The higher doses seem to quell the food noise in their heads.

But when you stop taking it, it goes away and people feel hungry again.

We were typing together 😊

[Mrs Tiggywinkle Again]

1 minute ago, Grace Hopper said:

We were typing together 😊

Haha.  I think a lot of people think these drugs are magic fat busters and work by melting off the body fat.  In reality, they work for weight loss because people eat much fewer calories when they’re on these drugs.  I don’t feel hungry at all and even when I eat I only eat about half a portion.

[Myra]

2 hours ago, Halftime Hope said:

@KidsHappen Definitely research berberine and give that a try. It has so much good research, and it's not harmful.

I have a two family members who are on Mounjaro and on Wegovy. It is not helpful in the long run. For the young one on it, I don't know what the %^&* his doctor was doing, putting him on it. He's young, capable of being fit, has no other health concerns other than being overweight, and should tackle this problem with lifestyle changes. It makes me so angry that he is not getting wellness care. 

 

Breaking the cycle of food addiction could be considered wellness care.  Taking Mounjaro and/or Wegovy could be an integral part on the road to recovery by jump starting weight loss. 

Food addiction can be one symptom of many overlaying conditions such as depression, high blood pressure, etc. 

Losing weight can be one part of combating the psychological and physical health as it offsets the pressures that society and/or oneself puts on an overweight younger person.  These pressures contribute to depression, low self-esteem, lack of will to make life style changes, etc. 

Perhaps this is part of the wellness care - only the doctor and patient (and most likely not shared with other family members) know all the facts that pertain to one's health. 

Just a thought to consider.

 

[zimom]

I have been on Wegovy and then Mounjaro for about a year.  I have lost 70 pounds.  My insurance last year covered Wegovy, changed insurance and this one covers Mounjaro, no questions asked.   

This is not medical advise...  I plan to stay on this.  What I am doing to keep a supply:  I get the 15 mg but I only take about 5 mg now each week for maintenance.  I take the 15 mg pen and "inject" it into a sterile vial I purchased on Amazon.   I then draw out 5 mg worth using a syringe and just inject that.  Then I get 3 weeks worth with 1 pen.  By doing this I have survived during shortages and hopefully have a backup supply should I have insurance issues down the road.   Plus a smaller dose is working for me for maintenance.   Obviously you have to know what you are doing and feel comfortable doing your own injections.   

 

[Grace Hopper]

18 minutes ago, Myra said:

Breaking the cycle of food addiction could be considered wellness care.  Taking Mounjaro and/or Wegovy could be an integral part on the road to recovery by jump starting weight loss. 

Food addiction can be one symptom of many overlaying conditions such as depression, high blood pressure, etc. 

Losing weight can be one part of combating the psychological and physical health as it offsets the pressures that society and/or oneself puts on an overweight younger person.  These pressures contribute to depression, low self-esteem, lack of will to make life style changes, etc. 

Perhaps this is part of the wellness care - only the doctor and patient (and most likely not shared with other family members) know all the facts that pertain to one's health. 

Just a thought to consider.

 

Excellent points. I do believe these are beneficial drugs. At the same time, I believe highest lasting success comes in conjunction with therapeutic lifestyle changes (developing good nutrition habits, exercising in a way that best suits one’s circumstances, counseling). 
 

[Dmmetler]

If your A1c has been above 5.7 for a prolonged period of time, insurance will usually cover diabetes meds as a preventative, but most companies require a trial of a less expensive med before approving Ozempic/Montjaro. (It's apparently such a common question that my endo's office had signs up about it in the waiting room when I last went). If you're already on a med or have tried it and don't have the effects you want, (including weight loss), there's a higher chance of approval. 

 

Be aware that your deductable and out of pocket maximum will likely apply first if it's an off formulary medication, even if they approve it. 

 

It makes sense to me that a medication doesn't change the underlying situation. I'm on multiple meds that I'll be on the rest of my life. It's not due to lack of self control or bad habits or being a bad person. It's that treating and curing are two different things. Ozempic, et al, are a treatment for obesity. They are not a cure. 

 

 

[Mrs Tiggywinkle Again]

My A1C went from 12 to 4.8 on Ozempic. My PCOS symptoms are gone.  I lost 85 pounds and my liver enzymes went from bad to normal.

It makes me nauseous and on day 2 or 3 after injection I have a lot of body aches.  Overall though it’s been good for me. My insurance covers it due to diabetes.

[ScoutTN]

53 minutes ago, Dmmetler said:

If your A1c has been above 5.7 for a prolonged period of time, insurance will usually cover diabetes meds as a preventative, but most companies require a trial of a less expensive med before approving Ozempic/Montjaro. (It's apparently such a common question that my endo's office had signs up about it in the waiting room when I last went). If you're already on a med or have tried it and don't have the effects you want, (including weight loss), there's a higher chance of approval. 

 

Be aware that your deductable and out of pocket maximum will likely apply first if it's an off formulary medication, even if they approve it. 

 

It makes sense to me that a medication doesn't change the underlying situation. I'm on multiple meds that I'll be on the rest of my life. It's not due to lack of self control or bad habits or being a bad person. It's that treating and curing are two different things. Ozempic, et al, are a treatment for obesity. They are not a cure. 

 

 

This. Ozempic is effective for my type 1.5  diabetes (autoimmune - not lifestyle caused), but my insurance would not cover it until other meds failed to work. Ozempic, along with diet and exercise, is just keeping me functioning, keeping my blood sugars manageable. At some point the autoimmune attack will win, my body will no longer produce insulin, and I will be insulin dependent. But currently, without Ozempic  or something equally effective, I’d be in the hospital with crazy high blood sugar. I need it to live.

 

Edited June 1, 2023 by ScoutTN

[Loowit]

My insurance will not cover anything related to weight loss, including medication.

My doctor talked about prescribing Ozempic for me, but I wasn't very interested after hearing about the side effect and that it was going to be a life long commitment.  I think it is great that it works so well for other people, but it wasn't for me even if I could afford to pay out of pocket.  I have fortunately been able to lose weight, about 40 pounds, using other medications which I am taking for other conditions plus lifestyle changes.  Sadly, I still have a lot to go.

[Jean in Newcastle]

5 minutes ago, Loowit said:

My insurance will not cover anything related to weight loss, including medication.

My doctor talked about prescribing Ozempic for me, but I wasn't very interested after hearing about the side effect and that it was going to be a life long commitment.  I think it is great that it works so well for other people, but it wasn't for me even if I could afford to pay out of pocket.  I have fortunately been able to lose weight, about 40 pounds, using other medications which I am taking for other conditions plus lifestyle changes.  Sadly, I still have a lot to go.

My insurance is like yours.  Weight gain (and what caused it) is more complex than people think.  I went from being underweight, getting chronic pain and fatigue, not eating a lot, not having an eating disorder etc. to needing to lose 75 pounds.  I was a semi-invalid and that messed up my metabolism big time.  I've been clawing my way back to exercise (as I said on the walking thread, I get over 10,000 steps now, hike often and am also lifting weights).  I have lost 25 pounds - hit a multi-year plateau - which has just budged in the past month.  I am on Metformin, which helps, but I've had to push my doctor to keep me on it because according to the numbers my diabetes is "under control".  But what he doesn't seem to understand is that it's under control because of the Metformin.  I'm now tweaking my Metformin intake against his advice but it's working and his advice wasn't, so there.  (His advice was that I should do IF (which caused my sugars to go way up out of control - YMMV) and that I was "overweight enough that I could stand to just eat every three days" (I"m still mad about that comment.) 

What I think is working for me (but saying this with fingers crossed because I never know when I'm going to hit another multi-year plateau) is managing my blood sugars with diet (Mediterranean diet for me works best), exercise which includes hour long walks and hikes and lifting weights as well as daily gardening, testing my sugars constantly and tweaking my Metformin as I go.  I don't need to suppress my appetite but other people might. 

[Dmmetler]

1 hour ago, ScoutTN said:

This. Ozempic is effective for my type 1.5  diabetes (autoimmune - not lifestyle caused), but my insurance would not cover it until other meds failed to work. Ozempic, along with diet and exercise, is just keeping me functioning, keeping my blood sugars manageable. At some point the autoimmune attack will win, my body will no longer produce insulin, and I will be insulin dependent. But currently, without Ozempic  or something equally effective, I’d be in the hospital with crazy high blood sugar. I need it to live.

 

That's useful to know. Right now, Metformin seems to be working for my LADA (after 5 years of being able to control it via being careful what and when I ate and exercised), but it's good to know there's a step up.

[Halftime Hope]

3 hours ago, Myra said:

Breaking the cycle of food addiction could be considered wellness care.  Taking Mounjaro and/or Wegovy could be an integral part on the road to recovery by jump starting weight loss. 

Food addiction can be one symptom of many overlaying conditions such as depression, high blood pressure, etc. 

Losing weight can be one part of combating the psychological and physical health as it offsets the pressures that society and/or oneself puts on an overweight younger person.  These pressures contribute to depression, low self-esteem, lack of will to make life style changes, etc. 

Perhaps this is part of the wellness care - only the doctor and patient (and most likely not shared with other family members) know all the facts that pertain to one's health. 

Just a thought to consider.

These meds are not a stepping stone; they are a lifelong requirement in and of themselves. I read up on the mechanisms, and the one that I'm really concerned about is the side effect of proliferation of fat cells. (That's the take-away that sticks in my mind from 4-6 months ago. I'm sorry I can't be specific or put it in proper medical terms after all this time.) The fat cells are held in check while you are taking the Mounjaro, but if you go off it, the rebound is worse than the starting point.  After I read the articles, I later found an explanation of it on YouTube from a weight loss doctor who prescribed it for his patients, and he restated what I had been reading, along with his opinion that it is very helpful for some patients, but that for young, relatively healthy patients, this might not be a first choice option.

I am very close to an old, sicker patient who doesn't have great options and is using it to reduce the amount of insulin used. That's a completely different story, but even so, the side effects are rotten way to live.

 

 

 

 

 

 

 

[DawnM]

18 hours ago, zimom said:

I have been on Wegovy and then Mounjaro for about a year.  I have lost 70 pounds.  My insurance last year covered Wegovy, changed insurance and this one covers Mounjaro, no questions asked.   

This is not medical advise...  I plan to stay on this.  What I am doing to keep a supply:  I get the 15 mg but I only take about 5 mg now each week for maintenance.  I take the 15 mg pen and "inject" it into a sterile vial I purchased on Amazon.   I then draw out 5 mg worth using a syringe and just inject that.  Then I get 3 weeks worth with 1 pen.  By doing this I have survived during shortages and hopefully have a backup supply should I have insurance issues down the road.   Plus a smaller dose is working for me for maintenance.   Obviously you have to know what you are doing and feel comfortable doing your own injections.   

 

This method is what I mentioned above and what I plan to do as soon as I get this next box of 1.0 pens.   I haven't taken it in 7 weeks, so I want to start with a lower dose and will do the method you mentioned to make it last longer.   

The question I have is this......Wegovy says their shots are only good for 56 days before they "expire" and aren't as potent.   56 days seems like a very short amount of time.   Have you stretched it beyond the 56 days?   Honestly, If I can make this box last 12 weeks if I have to due to shortages (0.33 mg per shot).  On .25 I was losing just fine and then went to .5 and had some bad nausea and gastro issues, so I think that .33 will kind of hit a sweet spot for me for at least a month or two.

Edited June 2, 2023 by DawnM

[zimom]

29 minutes ago, DawnM said:

The question I have is this......Wegovy says their shots are only good for 56 days before they "expire" and aren't as potent.   56 days seems like a very short amount of time.   Have you stretched it beyond the 56 days?

I have not had Wegovy in a good while so I do not have a box to see an expiration date but my Mounjaro boxes do not expire for quite some time.   If I use the contents of one pen over 3-4 weeks or 21-28 days, and keep it refrigerated during that time, I feel very comfortable doing so.  I am not seeing a decrease in effectiveness.   Additionally, I did have a good bit of nausea each step of the way up, but have had zero nausea or symptoms since decreasing my dosage.

Lastly, there have now been several reports and maybe even studies of these medications helping with addictive behaviors as well as possible cancer fighting benefits.   Obesity is a chronic disease, it is time it is treated as such instead of just telling patients to exercise more and eat less.   I feel so much better and my quality of life has improved greatly.  I am looking forward to being the parent and eventual grandparent I know I can be.   Before my weight was holding me back.  My children's grandparents were never healthy from a variety of things including obesity, diabetes, heart disease and strokes so for some of those reasons were never really involved with them.  Won't it be great to hopefully break that cycle?

 

[DawnM]

5 minutes ago, zimom said:

I have not had Wegovy in a good while so I do not have a box to see an expiration date but my Mounjaro boxes do not expire for quite some time.   If I use the contents of one pen over 3-4 weeks or 21-28 days, and keep it refrigerated during that time, I feel very comfortable doing so.  I am not seeing a decrease in effectiveness.   Additionally, I did have a good bit of nausea each step of the way up, but have had zero nausea or symptoms since decreasing my dosage.

Lastly, there have now been several reports and maybe even studies of these medications helping with addictive behaviors as well as possible cancer fighting benefits.   Obesity is a chronic disease, it is time it is treated as such instead of just telling patients to exercise more and eat less.   I feel so much better and my quality of life has improved greatly.  I am looking forward to being the parent and eventual grandparent I know I can be.   Before my weight was holding me back.  My children's grandparents were never healthy from a variety of things including obesity, diabetes, heart disease and strokes so for some of those reasons were never really involved with them.  Won't it be great to hopefully break that cycle?

 

I feel the same way and every time any weight questions come up everyone seems to feel the need to tell me exactly what diet I should be on (because they read about it, or their cousin is doing it, or their pastor has tried it......you name it, they will feel it their duty to tell me).   But this is the first thing that has worked in a very long time.

I am not looking to get thin/skinny, I am looking to be a healthy weight and if I am always a little plump but not in the "overweight" category, I will be happy.   I think the weight range for me is 101-134 with healthy right around 117.   If I am 130 I will be happy at this point.   That was my old "fat" weight 😅   But it is my new goal weight.

[math teacher]

Mine covered it for awhile, but stopped. Now i get it for $240 for a month supply.

[Christina78]

I had to fight with my insurance company for almost 4 months before they would cover it. I had to keep going back and forth with the insurance company and my doctor’s office (who also wasn’t very helpful). Insurance had the doctor’s office do a pre-authorization for each of the first 4 months as the dosage changed. If the deductible isn’t met, then I do have to pay full price. Luckily (or unluckily) my family meets our deductible pretty quickly. 

However, my best recommendation is to took for a “weight loss center” or “wellness center” in your city. Mine prescribed semaglutide which they would send out to be filled by a compounding pharmacy. I paid around $200/month total for monthly doctor visits and medication. So much less headache than dealing with insurance. I’ve lost 50 lbs so far!

[DawnM]

10 hours ago, math teacher said:

Mine covered it for awhile, but stopped. Now i get it for $240 for a month supply.

Why did they stop?   And are you getting the wegovy pen or using a compounding pharmacy semaglitide?

I am asking because now I am worried mine might stop covering it at some point.

[Pawz4me]

 I just saw this MedPage article and thought it might be of interest to some of you --

FDA warns on certain forms of compounded semaglutide

[zimom]

I saw that some insurance formularies have changed today June 1, to allowing Mounjaro, or not requiring a PA as it has been out a year.   So everyone, if you couldn't get it before, check your med formularies today.  

[DawnM]

9 minutes ago, Pawz4me said:

 I just saw this MedPage article and thought it might be of interest to some of you --

FDA warns on certain forms of compounded semaglutide

Those scare me!   And they are injected.....even scarier.