Some GLP-1 users were able to win back coverage by continuing all the possible options in the confusing world of health care.
Call for lost coverage
Bridget Roberts, 37, was reappeared for Zepbounde by remaining patient and persistent. It started when the resident of Pottsgrove, Pennsylvania, received a letter that her insurance company no longer covered GLP-1.
“At the start, I felt that I was condemned,” she said. “Something was finally working for me, and I was more alive than ever, and they wanted to take it to me.”
Switching diagnostics
Other GLP-1 users have successfully retained the coverage by modifying the diagnosis indicated on their prescriptions.
“Many GLP-1s are approved by the FDA for more than weight loss, including type 2 diabetes, reduction in cardiovascular risks and even prevention of strokes in certain populations,” explains Supriya Rao, MD, gastroenterologist and obesity expert in gastronomic consultants in Boston.
If your insurer has canceled the coverage for a weight loss medication, it may be the same medication for a different disease, such as sleep apnea or heart disease. A new prescription for a new condition “can make the difference between the complete denial and the full coverage”, explains Dr. Rao.
Brianna Johnson-Rabbett, MD, endocrinologist at Nebraska Medicine and director of the American Board of Obesity Medicine, offers some examples. “If someone has established cardiovascular disease and is obese or overweight, Wegovy can be prescribed by this indication,” said Dr. Johnson-Rabbett. “If someone has moderate to severe apnea and obstructive obesity, Zepbound can be prescribed for this indication.”
However, switching diagnostics are not a cover guarantee. “Insurance can always decide not to cover a medication, even if the FDA indications to prescribe these drugs are respected,” explains Johnson-Rabbett.
Search for discounts
A variety of discounts may be available from manufacturers.
The manufacturers of Wegovy and Zepbounds offer coupons and savings cards which can considerably lower your cost of the pocket for a year. However, not everyone qualifies for these programs, and they cannot be used indefinitely.
