Denied ozempic reddit

Denied ozempic reddit. It states that I had my doctor submit another authorization for Ozempic and it was denied. I was doing it for a year prior due to medical issues and it worked really great for the pain but when stress kicked in so did the eating. I lost 80lb and have maintained for over a year but always regained when I tried to taper off. Have been taking Rybelsus (oral version of Ozempic) since April 2021 for insulin resistance, my A1C was 5. My insurance doesn't cover ozempic, but it does cover wegovy (same darn thing), but requires prior authorization, so I'm waiting on that now (1 week and counting. Wegovy was out of network. Was pleasantly surprised to see that my benefits covered the cost ($244 total cost of pen) and just had to pay the felix dispensing fee ($12). There is a current nationwide shortage of ozempic that actually might have affected that because no one can get it. i have BCBS PPO and they denied wegovy straight up and after back and forth for about a week have fully denied Ozempic because i do not have T2 diabetes. I'm not a diabetic. My insurance denied ozempic and approved wegovy but wegovy is way way way on back order. Tell them you’d like a copy of the PA denial. After my appointment I checked my portal and saw that she put in the prescription for . Did this happen to anyone? I didn’t appeal because my doctor told me across the board the makers of Ozempic changed the requirement. Bonus- my overall health is I have been seeing a lot of posts regarding issues with insurance coverage on medications, specifically GLP-1 analogs (Ozempic, Wegovy, Mounjaro, Zepbound). They submit pre-approvals for each at the same time and insurance will review each individually. Hope that helps! I hope you can get a savings card or discount to make it affordable. My doctor argued with them for 2 hours provided lab results and all other documentation they requested and said it would be reviewed on 08/01/2023 when cigna does a medication review but until then i was denied. Post your question or story about Ozempic and connect with others who have experience with the same Call your insurance yourself and find out why it was denied and if your plan covers any of the medications. I was denied for both. Weirdly, it gets filled for $25 every time. My insurance denied Ozempic so I have been on Synjardy which is a metformin pill I take twice a day with food. I started taking Ozempic in august but due to shortages of over a month (I couldn’t get it the entirety of November) so my doc put me on Trulicity until supplies for Ozempic rebound. She told me to get off of it immediately. My doctor and I fought my insurance for about six months to get me approved for Ozempic rx but they denied all my appeals basically saying no because I wasn’t a full-blown diabetic yet. Has anyone who had an appeal approved or denied gone through a second review? Any difference between wegovy or Ozempic or is it the same formula with different name? I’ve been on this for two weeks (Ozempic) and omg my life is better. I’m also PCOS and insulin resistant/pre diabetic. I paid full price this month but can’t afford to do it again. Then, the pharmacy sat on it for a week befor sending it back to insurance for pre-authorization. All done by text. I’m not too hopeful. However, I have only lost 6 lbs in 3 months. My bmi is 37 amd insulin fasting is 18 (upto 17 is normal) How can I appeal to approve ozempic for weight loss ? Any other alternatives ? Edit: Talked to rep again, pre Ozempic DENIED . I got more help from the pharmacy staff than Caremark. But have been off it for years. Premium Explore Gaming View community ranking In the Top 5% of largest communities on Reddit. Now that they have my listed allergy to Metformin, they have now What are some things you guys have done once being denied by insurance. I was denied from day 1 so I had to hunt it down online. As of July 1 the formulary/prescription part of my insurance changed and now they are denying my refill. My insurance denied it, so I will have to pay out of pocket for the medication- I've had the prescription at the pharmacy for 3 weeks now, but they are unable to fill it because of the shortage. Ozempic, trulicity, and Mounjaro are technically suppose to be used for type 2 diabetes so unless you have that ICD-10 it’ll be 98% more likely to be denied since insurance can argue hey you have these other issues, but not the type 2 I’m not diabetic either, and I have OptumRX but they covered ozempic for me, without even a prior authorization. I’m planning to appeal once I get the formal denial letter, so any help is welcome. I’m not sure why mine was denied. If approved, they just send the prescription to your pharmacy. 75 and then 2. My most expensive medication is Breo which is charged at $20 monthly . I was given Ozempic about 6 months ago and have lost 60lbs, but my doctor went to refill my next one and it I was initially denied but turns out ozempic changed their packaging and so CVS contacted the pharmacy and had the doctor resubmit my prescription for the new one and there was no issue. Remember that a balanced diet, consistent exercise, and expert counsel are the foundation of a holistic weight loss plan. I’m vegan, eat extremely healthy, and workout daily. It makes no sense. 5, I started losing more hair than usual and freaked out. I will need to pay out of pocket for this and I just need some help trying to find affordable options. However I noticed that the prescription she put in was semiglutide (ozempic). 39K subscribers in the Ozempic community. I am on two medications to help my A1C. Diabetes or nothing. Is it typical for PA to be denied and does anyone have experience with an appeal? What needs to be pointed out, specifically if A1C is borderline but BMI, high blood pressure 578 votes, 91 comments. However, many lose on it. Still denied even though I'm pre-diabetic, have hashimoto's thyroiditis, hyperlidimia (high cholesterol), high risk of type 1 (when I was young) and type 2 as my parents both have diabetes and I have a history of the last 10 years being in a weight loss program and trying all other options. Intermittent fasting. That Wegovy isn't covered but I could submit a coverage exemption for it. 7. Go to your insurance website and login. Or check it out in the app stores     TOPICS. However, it’s time for me to refill and the insurance won’t cover it this time, I gave my doctor’s office at call and then told me the insurance said it’s not medically necessary. The issue manulife said is that ozempic is a step 2 drug, which means they won't approve it if you haven't taken the step 1 drugs first. If your insurance company denies your prior authorization for Ozempic, it doesn’t mean you can’t get coverage. Lab work came back positively - A1C and insulin are improving thanks to Ozempic! Down about 15 pounds. I use OrderlyMeds and been very satisfied. Honestly in my personal experience, I didn’t do much different than before, but before ozempic I was already eating alright and doing lots of exercise, I think ozempic just helped my body respond better to what I was doing lol. I do have insulin resistance, PCOS, and a high BMI. I went on hormone replacement (Dr said my levels were fine, they aren’t) and Ozempic. I tried everything else too (Saxenda, Wegovy) and got denied because my plan (like most) has weight loss medication exemptions Get the Reddit app Scan this QR code to download the app now. It's very expensive to pay straight retail so I was wondering if anyone else has overcome this problem? I have Blue Shield. Sure enough, insurance denied. I know that CL is cracking down, and asking for pre-assessment. Some people are just non responders. I have no idea why it sometimes get denied and other times gets approved. I contacted Prime Therapeutics (the admin of prescription drugs for Florida Blue) and was told only Ozempic and Mounjaro are on the formulary with a $10 co-pay. Q&A. My insurance denied ozempic and approved wegovy but wegovy is way way way on back I have CIGNA OAP, and Express Scripts is the PBM. I am thinking about appealing this decision as many people in my family have T2D and I am terrified of I was on Ozempic for 14 months and have now been on Mounjaro for 2 months since I didn't respond strongly to the highest doses of Ozempic. Or check it out in the app stores Home Insurance denied Ozempic Trigger Warning So this is so BS and I am soooooooo raging 😤 I was prescribed Ozempic in October and BCBS covered it. They denied covering an Rx I had for Rybelsus, but that’s because I’m not diabetic (yet). CherryGarcia88 • Most people who need to purchase out of pocket either go to Mexico or order from one of the Canadian pharmacies that ships to the US. I called my doctor to see what’s going on and they’re telling me that my insurance has denied it because I need type 2 diabetes. 5% of employers with fewer than 5,000 employees cover weight loss drugs, and 45% Because the F. Basically just split my last dose in half to get me one week longer (was on 2mg dose). However, doc wanted to up me to 1mg. I got yeast infection from Ozempic, couldn’t get Trulicity (and it made me horribly nauseous)at all in January and so I got switched to MJ. Explain to them that you are being denied because of no t2d diagnosis and What routes have others taken to obtain Ozempic when they were denied or don’t have coverage? What are some of the things learned and challenges faced? My doctor said Trulicity doesn’t work as well as Ozempic. Had no problems getting it with TriCare For Life via Express Scripts, once we got the PA form figured out (key was Step2, Question 3 needs to be answered YES). Has anyone had help getting a prescription through their doc for it and have you had any luck getting it covered? Also, how much does ozempic cost without insurance? Surely it has to be cheaper The typical Ozempic user needs doses in the higher ranges (around 2. Reddit . i recently finished my savings coupon and have been frantically trying to find a way to get semaglutide. ’s drug shortage website lists as Ozempic as “currently in shortage,” compounding pharmacies are allowed to buy semaglutide from pharmaceutical The FDA is investigating counterfeit Ozempic in the US drug supply. Doctor also had to document me using other weight loss medications first without much change in weight and bmi before I got it. com program that offers a weight loss program that includes Ozempic, Wegovy and Semaglutide which looks appealing, but before trying it I wanted to know if someone from the community has tried it and vouches for it. I got my ozempic prescription through Felix as many others have! Pretty easy process- just had to get bloodwork and a BMI check with the provider (quick video chat). They won’t pay for a medication that is for weight loss. Initially my wegovy was denied, so my dr prescribed ozempic and just wrote that I had elevated blood sugar. I have Blue Shield. 3. I anticipate being EXTRA hungry and even out of control when I come off of ozempic. Just thought I'd share my experience. I asked my doctor if it was possible to please prescribe me Wegovy, while keeping the Ozempic prescription, so I can keep getting it refilled whole going for the PA process AGAIN now for Wegovy My doctor agreed :). 25mg & dosed up 1mg. XXXX, says she has had great results for her patients on anti-obesity medications like Zepbound, Ozempic, and Wegovy First tried to get on Ozempic with VA, they said only those that have been on it already can keep getting it, and new applicants get turned down. My last resort is to try Ozempic to try to get my life back that I once knew. I got my ozempic from Canada 3/7/23 (2 days earlier woohooo), I had to pay OOP now crossing my fingers for Hi all! I just got denied ozempic. Ozempic is a tier four drug for me and requires prior authorization. My side effects of nausea and indigestion and stomach cramping were more noticeable at first and got better and now have returned with my increase in dosage. This past week insurance stopped covering and I was denied for Wegovy because I have a normal BMI. Or check it out in the app stores   Denied again by Cigna. And then was set the blood test, I did it, sent it back, was approved for Ozempic (as everyone is, I’ve never seen anyone say they weren’t approved through them) but then after everything my insurance denied it. Tell them you know they received the denial letter and you’d like for them to complete the appeal. On Ozempic, I felt so much more relaxed and happy, drank way less. My insurance denied it and out of pocket it is $3,000 where I live so I ordered it from Canada for $300. You can still get saxenda or another GLP1. It is the pill form of Ozempic. 0mg, he told me that I can titrate as I need. I have CalPers Anthem Blue Cross (common insurance for governmental employees in California. Once/if you need to go over 1mg, move to Wegovy. My doctor tried one more time with a prescription for Rybelsus and they finally approved it, but I’m dreading the day I get kicked off My insurance denied both :( I was on Ozempic for 15 months and when I went to get my refill they denied it. New. (Medicaid,Medicare and tricare). Or check it out in the app stores   My doctor did the PA but it was denied. There is no advice to get that medication. This is so disheartening; I just want help to get healthy. Ozempic is Is anyone else now being denied Ozempic after months of use? I have Hashimoto’s and PCOS, I got really sick this year, gained a ton of weight, and hit 340lbs. With a lack of information, I'm not sure if I can trust them. Or check it out in the app stores     TOPICS My Blue Cross Blue Shield of Michigan denied it. I got one, and cvs caremark denied it. For example, my insurance coverage policy states that Ozempic (any GLP-1) is covered for people with T2D who have failed on metformin. Week before last I received a message that my insurance approved Ozempic, which was sent to my local pharmacy. Has anyone had a similar experience. I have BCBS and pay for one of the more expensive plans for better coverage - they confirmed it was covered but didn’t tell me until now that it has to be coded with type 2 diabetes. 5mg weekly. So if you use it to start, you’ll waste money, but if you use it after you Has anyone gained all the weight back if you’ve continued eating as you did while on Ozempic? Help. Cost is about $275 per month. The side effects, less so. Has anyone had this happen? For background, im newly diagnosed with IR PCOS. I ended up getting Ozempic in TJ, had great success on it but ran out after 1. I tried to get a Prior Authorization approval, but they denied that as well. View community ranking In the Top 5% of largest communities on Reddit. D. Does anyone know any good coupon codes that Skip to main content. Chemically they are the same just prescribed for different things. It looks like they provide similar services as Felix ( acne, birth control etc,) but felix doesn't offer Ozmepic yet in Manitoba, and yet livewell indicates they can. That’s gonna have to do for me until 2026 - when Ozempic goes generic. Instead, consider Rybelsus. Ask your pharmacist if that’s the issue, if it is your doctor just need to resubmit it. I’d do Ozempic until you need to move past the 1mg dose, it will save you about $600. A. They examine each person's health history, preferences, and goals to adapt their counsel. Dr. I have been eating healthier and exercising 4 days a week. When they said $80 Euro each, I said give me all the pens you have! I have not tried to refund or cancel, but I think I’m going to. I'm healthier, eat better and less, have lost a ton of weight, look much better. I feel confident that I'll be able to maintain my weight after Ozempic because of Certain GLP-1s while they help with weight loss and comorbidities the key factor is FDA regulations. That means that you have been denied, but you are appealing anyway. I've since gotten a letter from my doctor for special approval and it's in the process of being either approved or denied. I went up to 35 BMI in a year, though I improved my fasting blood sugar to 98. No hidden fees. I was denied coverage. (I cannot wait for that day. 5 injections. She also told me she wants to do a new EGD and test for I’m switching right now from Ozempic . Ozempic, you’ll get your T2D under control and “might” lose some weight, but it’s not Per your health plan's criteria, this drug is covered if you meet the following: (1) You are not taking this drug with any of the following: Semaglutide-containing products (for example: Ozempic, Rybelsus) and glucagon-like peptide-1 receptor agonists (for Has anyone been denied ozempic/wygovy/mounjaro because their BMI was just under 30? My BMI teeters between 27. Certain GLP-1s while they help with weight loss and comorbidities the key factor is FDA regulations. Hoping to hear how your Ozempic or Wegovy should be chosen based on health, personal preferences, and medical guidance. For what it’s worth the op, I have type 2 diabetes, pcos, obesity, and have been on metformin for 3 years and insurance still denied me. They gave me a prescription for Ozempic, which was denied coverage and Anthem BCBS offered Metformin. I am going to try Insurance denied . $249 a month for up to 2. I get my Rybelsus from Marks Marine Pharmacy Although Ozempic tells me as of Jan 21 2020 they have FDA approval my cigna insurance wont cover it if im not diabetic. 4 and 29. I tried everything else too (Saxenda, Wegovy) and got denied because my plan (like most) has weight loss medication exemptions I signed up, the monthly subscription fee was $100 when I did it. You’ll have to pay for Why coverage gets denied. Sriniwas Vanga was among the first MLAs to join Mr Shinde in his rebellion against Uddhav We would like to show you a description here but the site won’t allow us. Insurance First, it took so much effort to convince my GPR to write a prescription. Does anyone have any suggestions or other resources? I can't afford to pay 1k out of pocket to pick up the prescription. I read about Mounjaro I am now having to pay 1,000 a month for the med and want to switch to Wegovy. You go to a doctor for trust and their education, not to be a guinea pig. Or check it out in the Prescribed 8mg pen with 0. Reply reply More replies View community ranking In the Top 5% of largest communities on Reddit. Were you denied by Sunlife? I am wondering if anyone is paying out of pocket for Ozempic and how much does it cost in the US to get (thru Polar Bear Meds) in Canada to order thru. Over it. My doctor had appealed it and everything. However some people seem to have had luck, try calling Novo Nordisk and ask them for more information. I expect that they will get better with time, and since I’m doing this for my overall My doctor prescribed Ozempic and insurance denied it. I was denied coverage in February for Wegovy, Ozempic and Mounjaro because I didn’t have diabetes. My BMI is nearly 38 (obese>30). Are you good results with it? This was exactly my path too. Tried so hard to get a pre-auth and appealed 3 times. Reply reply more reply More replies More replies More Although Ozempic tells me as of Jan 21 2020 they have FDA approval my cigna insurance wont cover it if im not diabetic. The cost at the I get my Ozempic from Canadian online pharmacies. It was AWFUL. insurance denied ozempic coverage . I filled it at the pharmacy for my normal copay. However the higher dosage of Ozempic is usually prescribed for weight loss too so I think they just thought it was someone trying to slip through. That’s usually the case. Hi folks- I’ve been on Ozempic since early February. I got my ozempic from Canada 3/7/23 (2 days earlier woohooo), I had to pay OOP now crossing my fingers for I’ve been on Ozempic for six weeks for weight loss. How have others dealt with this? I’ve been so successful on Ozempic- I really don’t know what I will do if it’s denied. I’m normal and am Not thinking of food all the dam time. A few months after the episode aired, Lizzo was accused of taking the real Ozempic to lose weight and denied the claims, which makes her costume all the more ironic. Insurance still said no. So the pharamcies I use we have to order the drugs first (they have many available). I wasn't even planning to buy Ozempic but I happened to walk into a pharmacy to get some toothpaste during my trip and I was curious how much Ozempic cost. That is what he recommended, and also told me to adjust as needed as of this morning, he said it’s perfectly ok to take 1mg every 5 days, then when I’m ok with that 1mg every four days and eventually try 1. My initial PA has been denied for Ozempic as well because my a1c isn’t at or above 7-it’s 6. Log In / Sign Up; I am so defeated. Wegovy is weight loss Ozempic is T2D. They also confirmed by phone that Ozempic and Mounjaro are only approved for diabetes on their formulary, not for weight loss. Did you write an appeal? Did you go through a Weightloss company? Did you start using it compounded? Update: My doctor submitted a pre approval for Wegovy. We can lose weight on our own, and these insurance companies obviously are very well aware of that. Metformin didn’t work for me 😔. Has anyone gained all the weight back if you’ve continued eating as you did while on Ozempic? Help comments I'm in a situation where my insurance denied Ozempic because I'm not diabetic although I am pre diabetic. It is the next step. UPDATE 2: My PA for ozempic was denied. I am taking Ozempic and my insurance is through Sunlife. Luckily, I have spent a long time learning how to balance my blood sugar and manage my insulin resistance prior to starting ozempic. So I would have had to pay Ro the same I’ve already had one for Mounjaro that was denied twice. I would like to start ozempic sooner rather than later. I lost weight slowly but had minimal bad side effects. A fatty liver and hypertension are not even going to be enough. Top 2% Rank Hi all! I just got prescribed Ozempic by my Dr, but unfortunately I got denied coverage by my insurance. 5. I don't have a PCP so I was looking at online ones, but I don't want to spend the out of pocket costs to be denied a prescription. Eventually my A1C was back up over 6% because metformin alone couldn’t cut it. Still . Makes me question the I’ve been on ozempic for almost a year now, really seeing the peak of my numbers improving & weight loss within the past few months. My insurance just denied coverage of Ozempic even with prior authorization form. Internet Culture (Viral) Amazing; Animals So everybody’s body is truly different. It was $349. You are a T2 diabetic, and Ozempic is specifically for that! And you just do an injection once a week with Ozempic, and barely feel it. Still expensive but doable. Once you need to go above 1mg Ozempic, the cost is $630. But also the journalist poking around reddit reporting everything we discuss here also played a part in this. So I would have had to pay Ro the same My BMI is nearly 38 (obese>30). They won’t cover it for me even if I do metformin again first. According to what I was told both by my doctor and Member Services, my health care insurer and provider (Kaiser) will only cover Ozempic prescriptions to diabetics, and only with the following additional restrictions: A1C has to be poorly controlled even with other documented attempts to lower it My health insurance (Aetna) uses expresscripts for prescription management. Ozempic is tested and approved for type 2 diabetic people. I confirmed that again just this week. Even in the 6 weeks I was on it, I lost almost 10 pounds. com program that offers a weight loss program that includes Ozempic, Wegovy and Semaglutide which We’re 1 day old, be patient with us. 5 lbs a week on average. I have been on Ozempic for weight loss and high BMI for 6 weeks, and when I went to get my new pens, I was informed that I needed a PA. I had an appointment on Monday and was prescribed ozempic. If you can't get ozempic, try rybelsus, even though it's a pill i WOULDN'T knock it down because when ozempic was on shortage I was able to find rybelsus. Doctor sent PA, denied again. It's genetic for a lot of people and we could not help it. Expand user menu Open settings menu. I have a couple questions. A year ago, I was denied approval for Saxenda for weight loss (same active ingredient at Ozempic) at 33BMI & pre-diabetic. Accomplishments! I’ve already had one for Mounjaro that was denied twice. Old. It could’ve been the Ozempic, not getting enough protein, or mourning the loss of my cat. Any and all tips and ideas are I’m concerned because I’ve been doing research and ozempic is indicated for diabetes/pre diabetes which I don’t have, and I’m not sure if my risk factors are enough to push my doc. My insurance sent a notice saying they will not cover any GLP-1 meds, which include both Ozempic and Wegovy. She had to stop Ozempic due to insurance no longer covering. Are you good results with it? I have Blue Shield. My 3 blood pressure meds previously cost anoth $80 a month, now are $20 each for a Insurances cover Ozempic for diabetes. Just keep trying different meds to get approved maybe? It’s so frustrating trying to understand I am active, ie snow ski, cut, split and stack wood year round and never lose weight. However, this time it seems to be moving differently. Guess I just wait it out til I finally get the gold star of If they denied it saying it's for weight loss, I'd have your doctor redo the prior auth. Sort by: Best. Is it typical for PA to be denied and does anyone have experience with an appeal? What needs to be pointed out, specifically if A1C is borderline but BMI, high blood pressure I just got approved for Ozempic by BCBS, denied Wegovy though. I’d signed up for Calibrate but was dropped after my insurance denied Wegovy & Ozempic. They will not budge even with my doctors appeal. My a1c is 5. I'm on 0. After suffering miserably for weeks, I asked my doctor if it was necessary for me to be on metformin as I thought that was to blame for my constipation . It seems to be a newer site, so things like trust pilot do not have a lot of information on them. My doctor filled out the pre authorization paperwork and it My doctor prescribed ozempic back in December. ) I’ve been prescribed 2mg Ozempic by my PCP and I am about to take my first dose today. Having Recently active Ozempic forums and community discussion threads. 5 Ozempic. On ozempic it's a breeze. Its a breeze on ozempic. Reply reply [deleted] • I’ve lost somewhere between 10-15 lbs depending on the day. I'd rather not Hier sollte eine Beschreibung angezeigt werden, diese Seite lässt dies jedoch nicht zu. They said I have to go see a physician in person and can't help with anything due to my thyroid Also it's only ozempic that is banned. Has anyone used the pens that far past the not too bad for that pricehave you looked into good rx for a discountor I have seen some ozempic coupons Sorry - I had to open it up to find my original prompt: “Write a letter to Blue Cross Blue Shield of Illinois requesting an internal appeal and formulary exception to prescription of Mounjaro for treatment of Type 2 Diabetes and mention previous use of Metformin, Actos, and Ozempic, which caused severe intestinal symptoms and cite studies showing that Mounjaro works better with First tried to get on Ozempic with VA, they said only those that have been on it already can keep getting it, and new applicants get turned down. On Ozempic I lost almost 30 lbs and was just up to 2mg/wk dose. My doctor is in TX and understands the issues with US insurance getting ozempic approved. They requested a prior authorization and then denied it because I am not diagnosed with Type 2 diabetes. Insurance covered Ozempic! Insurance covered Ozempic! I was denied coverage of Wegovy by my insurance (CA Anthem Blue Cross); they said they don’t cover “obesity medication” and it would have been roughly $1250/month out of pocket. I just switched insurance companies to United Healthcare. I called their customer service line and had them walk me through how to find what's on the formulary online. I hope if I can’t get it that I can just get the script and try and order it in Canada. I probably should have Sadly, my PA was denied today due to Mounjaro being excluded by my plan. I didn’t lose weight on ozempic until the 1mg dose (and I was wasting healthy and working out consistently even before starting the med). I was denied for both with UHC. 0 mg) to experience consistent, predictable appetite suppression and weight loss. They submitted it and it was denied. Controversial. My previous insurance approved it with no problem last year. But in particularly, I definitely ate less (due to ozempic) and made sure to eat less fast food, drink more water, and i run for exercise, but even on days I am currently on 10 medications including my choice of Ozempic or Wegovy, my husband has 4 prescriptions. I don’t see many posts about individuals having bad reactions to Ozempic so I thought i’d share what happened to me. I was on the prescription assistance program before I switched to this insurance. I was really upset yesterday, as, like I said, having the G7 has really changed by life and outlook. Problem is I do not have insurance at the moment and won't have it until November. It was $130 a month with Express Scripts and my previous continuation of coverage under my retirement plan. I had resolved to pay out of pocket, but somehow my new doc suggested we tried to get approved for Ozempic which is much cheaper than Saxenda What to do if your prior authorization for Ozempic is denied. I am 5'6 female, 232 pounds, so my BMI is about 37. All our PAs were denied including WeGovy :( so I’m on metformin now. com after combing through Reddit. My bmi is 37 amd insulin fasting is 18 (upto 17 is normal) How can I appeal to approve ozempic for weight loss ? Any other alternatives ? Edit: Talked to rep again, pre My doctor prescribed Ozempic and insurance denied it. My doctor completed the prior authorization but it was denied any tips on getting it approved or appealing since I have been on it for six months with great You may want to look up Wegovy and Ozempic on your health insurance formulary. She Insurance companies will likely cover Ozempic for Type 2 diabetes. Reddit is for being judgmental, get off your pedestal lol. Mounjaro is, like Ozempic, for diabetes so unless you have a doctor who will prescribe off label and exceptional insurance coverage that wouldn't be an option without a diabetes dx. Someone here described it best my life doesn’t revolve around food and the noise from food is just gone. But didn’t even get a notice. I am non-T2D. Trulicity worked, but just slower for her weight loss. Ozempic is dosed at a level that is not considered therapeutic for weight loss, whereas Wegovy goes to a higher dosage and is specifically intended for weight loss. I probably only have about 10 to go, but I’ve been on Henrys for three months and lost nothing. You really have to understand how insurance works and how policies are My doctor prescribed ozempic back in December. You will find lots of stories in the subs about how the appetite suppression doesn't kick in for many people, or it dissipates over time. I do have rheumatoid arthritis and have gained over 100lbs due to the meds and steroids I've had to take to try and control it. Log In / Sign Up; My health insurance (Aetna) uses expresscripts for prescription management. I was denied ozempic and mounjaro but approved for wegovy & zepbound. I eventually got a new Ozempic pen and decided to wait and see if I could lose the 10 pounds on my own first. Or check it out in the app stores   My insurance denied Ozempic and I can pay OOP but jeeze it’s expensive. I was on Qsymia for 6 months paying out of pocket it worked but it stopped working and they wanted to increase the dosage which I wasn’t a fan of so I stopped. I want to get back on and lose another 20 lb. With Mounjaro, it was denied pretty quickly within 48 hours. Ozempic belongs to a growing class of medications known as glucagon-like peptide-1 (GLP-1) agonists. Writing for Ozempic knowing the insurance covers is for diabetes when the intention is for weight loss (when the same chemical with the weight loss indication isnt covered) is straight up fraud. The pharmacy couldn't get wegovy because of a nationwide shortage and got ozempic approved for that reason. Could you find a dr to do something similar? I was certain we’d need a PA because it’s supposed to be a step 2 drug They will also work with your insurance to get pre-approval for ozempic, wegovy, mounjaro and zepbound. Slow but steady and can't complain with results because I've been on the lower doses. Best. My mom, both grandpa's, my uncle, and my dad all have diabetes and none of them are overweight. If it's denied, it's denied, the insurance companies run the show. Cost is about $500 including cold shipping. Her endocrinologist wrote a prescription for Mounjaro, but it looks like that got denied as well. I’ve lost about 20 pounds and it has been life changing. 0 mg, and now I'm losing 1. I gotten ozempic from having really bad blood test, obese and borderline diabetes basically what my doctor told me. But her experience was she had more success on Ozempic. The Dr with Alpha is going to try and get a PA, but after I read the clinical criteria, my A1C is not high enough and it says weight loss is not an approved use. I called to check on the Ozempic appeal and they told me it’s under a second review. Even though my insurance didn’t change. I have tried many times to get pre authorization and appeals and always denied. I had her then try wegovy and I get zero discount on it. But that is my next plan! I’ve heard good things and $300/month isn’t horrible for soemthing that makes my life infinitely better! 13 votes, 30 comments. are the nearly the same price. Open menu Open navigation Go to Reddit Home. This happened only a few weeks ago which is why everyone’s refills are being denied now. They don't require a My wife and I were on Ozempic for over a year and had fantastic results losing weight and normalizing metabolic levels but weren’t diabetic. I do have a prescription, am I Nope, I used my USA prescription and it worked great, they just asked me for my passport. Open comment sort options. I’m glad you got it with WeGovy! Go luck! I have been on Ozempic for almost a year for insulin resistance/pre diabetes. I am breaking my back. My provider suggested moving forward with Ozempic since that's within my formulary. We’ve done multiple appeals and all are denied, my doctor refuses to do the peer to peer, I’ve spoken to appeals, pa, pharmacy, pharmacists. I read about Mounjaro My doctor prescribed Ozempic, but come to find out my insurance won't cover it. I live in California for what it's worth. My doctor is filing an appeal- even though my The two best things I’ve ever done for my health were initially denied by my PCP. Wegovy is $500 per pen, all doses. My insurance company denied my prior authorization for Ozempic for pre-diabetes/insulin resistance after I had been on it for a month - in this video I talk about why and what my next steps Real Ozempic users share their experiences with prior authorization denials in online forums like Reddit and Ozempic reviews. Once you order if you have a paper copy of prescription you can upload yourself with your order, email it to the email and include order number in subject line or you can have your provider fax over Yeah honey, breathe and relax. Do you meet that criteria? If you do not have diabetes, some insurance will approve Wegovy. I am so confused because my best friend who I work with and have the exact same insurance got it through her PCP and hers was accepted. Ozempic . That should give you an idea of what is required for them to authorize it. Some highlights from the Ozempic Reddit thread include: OpheliaHybrid was denied because they My insurance company has denied the coverage on the Dexcom G7. I figured hey no issue, I checked my portal and saw that pharmacy benefits manager for my insurance has denied me. You have the right to appeal the decision and fight for the coverage you deserve. Just this week, CIGNA called and told me both Ozempic and Mounjaro are covered - I’m receiving my first 90-day supply of Ozempic for only $70!!! I have no I’m switching right now from Ozempic . Wegovys indication is weight loss and i am sure 100% not covered, would cost 4k/month dose 😂. In my I didn’t appeal because my doctor told me across the board the makers of Ozempic changed the requirement. I am technically pre-diabetic at the moment with high A1C with a 30+ BMI. I don’t want to pay the subscription fee just to get prescribed a medication that is completely unattainable right now. It still works but it’s slower. I've gone through drastic weigh loss in the past using only exercise and nutrition without much luck (powerlifting,muai thai, keto, etc). The doctor has written a preapproval again, but Blue Cross Blue Shield has denied it. However, 1 week into the metformin and I started getting constipated, then I started on the Ozempic shots and it did not improve. Get the Reddit app Scan this QR code to download the app now. My group insurance does cover Ozempic and Wegovy as of right now, so I want to move forward before anything changes. My doctor disagreed and said it was the ozempic causing me Thanks for the advice, I’m going to try 1mg every 5 days first and see how I do with that. My insurance denied the prior authorization request my endocrinologist submitted. 25 and . 25 mg of Ozempic for four weeks and last week ramped up to . I'm going to restart Ozempic today, because I have more weight Get the Reddit app Scan this QR code to download the app now. I have used metformin in the past, and it is cheap. Even if you’ve tried everything else they want you to try first. If you don’t have T2D, they Get the Reddit app Scan this QR code to download the app now. My insurance covers it with a PA like yours. However, they are now out of stock until about Nov 1. My insurance denied it because my doctors office didn’t send them my a1c. My doctor completed the prior authorization but it was denied any tips on getting it approved or appealing since I have been on it for six months with great I know all insurances are different but I got denied a prior authorization for ozempic but got approved for wegovy. Your Doctor probably doesn’t want to take the time to do the appeal. 25, . I never imagined it was so cheap. ). Help! Looking for ideas on how to get the lowest out of pocket costs for ozempic or wegovy. 6. I have 2 doses left in my 1mg pen and it seems a waste to throw out if I can safety use it for 2 x 1mg doses. I have pcos. I found on Facebook a lifeMD. I'm thin and my diabetes cannot be controlled with diet alone. Had a friend that used both Ozempic and Trulicity. Not just because of looks, but you'll FEEL so much better physically. I did a bunch of research and eventually wound up buying from a “research chemical” site. I have tried everything and my doctor really got my hopes up with Ozempic. I started on . i do have insulin resistant PCOS which is why i was given wegovy in the first place. I’ve lost 60 lbs, gained a ton of muscle, and I’m in the best shape of my adult life. Some people are I got impatient and used Alpha Medical. My doctor seemed hesitant and finally said she'd put in a prescription for Wegovy. My insurance is requiring a PA for Trulicity starting in 2024. Combine that with a low carb diet and you will find yourself feeling way better. I’ve lost 60 lbs, They denied me 10 minutes after my doctor told them that I don't have diabetes. They don’t consider being overweight a medical problem. While trying to have my medication filled yesterday, I received an email stating prior authorization was required. The day after I picked it up I received a message from my insurance that it denied the prescription. I messaged my gastroenterologist and she told me ozempic causes gastroparesis, thats what causes the weight loss. Everything Ozempic Questions? Answers. You can always try a formulary exception. Well now I’m having what feels like withdrawal symptoms from You should also be able to look up the coverage policy for ozempic/GLP-1’s at your insurance company. 5 mg. 5 click dosing to save money after insurance denial. My wife mentioned the Ozempic Savings Card, but it looks like that's just used to help out when your insurance has already approved it and the price is still high. So I’ve had to appeal the denial from my PA due to me not being diabetic and not having tried the first option before ozempic. And after five days, insurance turned down the prescription. Reddit recently showed me an ad for joinlivewell . I cannot appeal or obtain approval because it's specifically excluded compared to only being non-formulary. Ozempic, you’ll get your T2D under control and “might” lose some weight, but it’s not Unfortunately I believe it only works with insurance. I pay out of pocket for my other medications but it's like 60 dollars for a months UPDATE 2: My PA for ozempic was denied. I was on metformin last year but BCBS said I needed to be on it sometime within 90 days prior to being prescribed ozempic. My A1C is the last point before hitting diabetes. It took me 3 months of no appetite suppression / weight loss to reach my effective dose of 2. Rant My doctor in NYC is now referring me to “weight management” because he has exhausted all options of getting my sh*t insurer, Cigna, to approve my medication. Get app Get the Reddit app Log In Log in to Reddit. I was on it and had to be switched off because of the shortage. (I have UHC and they will not cover any alternatives). I was just curious is anyone has been I’ve been on Ozempic and Metformin for five weeks started on . Go figure. ) They also require step therapy prior to approval, but I've been on metformin for 6 years and still gaining weight, so hoping it won't be an issue. They said I needed to be on a treatment for weight loss before going on Ozempic, diet, exercise and meds like Qsymia. After seeing a few comments here, I asked my provider for I’m really disappointed but maybe someone has advice. I subsequently ordered from Canada. I’m with Alpha Care now and they actually send over the PA trying to get you the medication. Was your PA for Wegovy or Ozempic? Depending on what your formulary says you may want to try for a PA for the other drug. I expect that they will get better with time, and since I’m doing this for my overall Get the Reddit app Scan this QR code to download the app now. I’d try to fill it and see if it gets paid. I haven't had to pick any up gecause the diabetes counselor gave me the first pen for free and said she would give me a second one as well. An appeal was then sent and that has since also been denied The two best things I’ve ever done for my health were initially denied by my PCP. You can ask Unfortunately I believe it only works with insurance. The irritating thing is that all the other class of meds, Ozempic etc. No medical reasons asked - but you can share if you want to and are respectful of others. ) Type 1 diabetic people do not take Ozempic. 25mg. But my A1C is "borderline" and my insurance has denied coverage. The agency warns against using products labeled with lot number NAR0074 and serial number Your doctor should have your records and A1C before you started Ozempic, and can use that, plus family history as proof you need Ozempic when filling out the PA paperwork. Had I listened to the Dr I’d probably still be 40+ BMI, prediabetic with a CPAP for sleep apnea. I was denied a semiglutide compound from a weight loss clinic today because 10 years ago I had thyroid nodules (no longer have them). Definitely do the appeal like everyone else said. If prior authorization is denied, you or your healthcare provider can appeal. I am in a similar boat. Finally got my Ozempic covered by insurance! I am a 27 year old female, 5’3, 175lbs, and just found out I am insulin resistant this summer. I have been getting it since February 2023, so not a new prescription. However, when I got to about 1. It's what I got approved for when I got denied ozempic. 4 and they say I need to try 2 alternative oral meds. They denied ozempic pre-approval with reason as only for diabetic. TL;DR I don’t think ozempic is a solution for disordered eating but it is definitely an effective weight loss tool Get the Reddit app Scan this QR code to download the app now. Here are the steps to take: Review your If approved, you can get Ozempic with insurance and only pay your drug copay. r/Ozempic A chip A close button. I would say almost always, but I don’t want to overstate things. I've been on phentermine for several months now and haven't lost any weight at all. We’re 1 day old, be patient with us. I generally fast 18 hours a day. Insurance normally do not cover other products for weight loss since they arent 'medically necessary'. On Ozempic I lost about hi everybody. If you’re having difficulty accessing Ozempic, there are several Ozempic DENIED. My insurance denied my Ozempic prescription after 4 months . I’m a Skip to main content. Some people do experience weight loss and Hoping someone here has insight after being on Ozempic for 10+ months (with insurance approval) they have now denied it. My doctor prescribed Ozempic and Wegovy to see which one my insurance will cover. Based on your experiences how long did your PA take? If I get denied coverage what are my other options for getting semaglutide to assist in weight loss. I have worked in collaboration with pharmacies, drug manufacturers, insurance plans, and physician clinics specializing in endocrinology to submit prior authorizations and write appeals for denied prior I got denied 3 times for Mounjaro when trying with my doctor, but was able to get Ozempic approved with Sequence. i’ve lost 54lbs on try for wegovy, same ingredients as ozempic but more leeway on insurances. This will be a great community soon! This is a safe place to discuss weight loss via Ozempic use. Honestly, I don't know how my insurance approved Ozempic for me, or what my doctor used as a reason for prescribing it. Share Add a Comment. Father has diabetes, I have BMI of 38, thankfully I'm 5'8. I know Tricare require you to be diabetic for drugs like rybelsus and ozempic, but I can’t imagine that’s the case with Wegovy, since it’s not approved as a diabetes drug specifically. My doctor prescribed me Wegovy for weight loss, and in CVS they are out of stock on those injections. I have insulin resistance, PCOS and deal with elevated cortisol levels. Has anyone gained all the weight back if you’ve continued eating as you did while on Ozempic? Help comments I know that Ozempic is all the rage and millions of people rave about how well it works but I still have a lot of questions before giving it a try. They are the same medication Reply reply Background_Hippo_160 • Marks marine in canada! Reply reply TXQuiltr • I was denied by I signed up, the monthly subscription fee was $100 when I did it. So weird. My BCBS won't cover wegovy or the other one. Father has Denied Ticket, E Shinde's MLA Repents Leaving Uddhav Thackeray, Goes Missing . Only ozempic and I must have a diagnosis of diabetes. My insurance denied me coverage even though I am a T2D and high I bought mine from buycanadianinsulin. Meaning it’s a slower loss than Ozempic. Irate. I'm in the northern US if that matters. I got all of that handled today and my insurance said it could take up to 30 days to approve or deny it. Is Ozempic or Wegovy on your insurance formulary? Then look up the PA criteria for each. I have had to resort to buying Ozempic online. All of a sudden, this month, I’ve been denied of getting my ozempic refill. I have been doing a carnivore diet for 4 weeks and lost the 10 pounds. Top 2% Rank I have not tried to refund or cancel, but I think I’m going to. Has anyone who had an appeal approved or denied gone through a second review? I’ve always been overweight but Started Ozempic because I was diagnosed with chronic kidney disease and losing weight means my kidneys don’t have to work as hard. It was also denied and not covered by the insurance. I did the telegraph appt. The next month it was ridiculous finding a pharmacy that had the shot and when I Get the Reddit app Scan this QR code to download the app now. Soon we’ll have mods, fixed topics and flairs. I’m pre-diabetic so I know the PA will not be approved I have Blue Shield. 5 months. Or check it out in the app stores   Denied by insurance . The script from my PCP had 3 refills. My insurance plan only covers it with a diabetes diagnosis (and even then requires step therapy with metformin first) . Hello, so they do offer compounded glp? There advertising seems ambiguous enough to hint at it but they also mention the name brands a lot. Most insurance require a history of metformin or other diabetic medication before If your insurance denied coverage for Ozempic, don't panic. She did not write me an RX for the compound pharmacy. Top. It is about as strong as 0. 25mg and insurance denied me, paid about $950 at CVS for my first pen. Will try to get an Ozempic savings card tomorrow, although I'm not optimistic. Learn about Medicare coverage and how you can get your insurance provider to cover Ozempic. I was on Ozempic and lost 30 pounds. It's ok. FAST You should just talk to your normal PCP, not your endo. The weight loss is amazing. Ozempic, trulicity, and rybelsus are on my formulary (no mounjaro, etc. I just got a letter saying my insurance now needs a prior authorization. I was so My doctors helped me appeal (twice, because Anthem also denied Trulicity) trying to tell them that my A1C was good because of Ozempic, but I was still denied. 50, and 1mg all cost $315. My insurance denied me Ozempic coverage after 5 months so I took the Compound route and been very satisfied. You have the right to appeal and, according to Reddit users who take Ozempic, you may have to appeal or request new prior authorization multiple times. But unfortunately have been on a waiting list for a weight loss clinic for over a year now, and my family doctor kinda pooped into thin air without notice ( and I'm still trying to find a new one) I am not diebetic and was denied when I first tried to claim. I am considering taking a second job and paying for Ozempic out of pocket or trying to get a cheaper compounded semaglutide but the prescribing doctor from Plush Care implied those weren't safe. Appealing will be my best option for getting it approved as it was denied, and my insurance does not have ozempic approved for weight loss, only diabetes type 2. I did some researching and it seems it's advised that you shouldn't take Ozempic if you or a family member have had thyroid cancer- I'm not reading anything about just nodules. I'm going to restart Ozempic today, because I have more weight to lose. I've been considering using Ozempic, however, it feels like I eventually got a new Ozempic pen and decided to wait and see if I could lose the 10 pounds on my own first. Just because something has one active ingredient it doesn't mean it's the same. I do not have diabetes so I don't believe I qualify for ozempic. I am not diabetic, but have pcos so that might a difference I choose Ozempic because it looks like this is the only drug my insurance covers per Aetna’s website when I input the drug name. 99 copay) for the past six months & for my most recent refill they required a prior authorization. I have pros, am insulin resistant and pre diabetic. This will show you what (if anything) is required to get it approved. reReddit: Top posts of November 6 Tricare is a government type of insurance. Be the first to comment Nobody's responded to this post yet. As a registered nurse I find it appalling to have such amazing results from GLP-1s to avoid diabetes, cardiac, joint issues etc and be denied until these health conditions arise. Where can I go from here? Get the Reddit app Scan this QR code to download the app now. And I needed to lose quickly so I’d have that impact sooner to avoid more kidney decline. My insurance has covered it ($24. I was denied Wegovy since my insurance won’t cover “anti obesity” meds, so now I’m trying Ozempic. Add your thoughts and get the conversation going. I asked about being prescribed Ozempic, Mounjaro, or Wegovy. I got the metformin filled yesterday. Anyone get denied after blood work/metabolic test from thyroid levels? I tried to go through Ro, did the blood work and my thyroid came back as 150. Ca. Insurance companies maintain their They charge 1000 dollars for 3 months because they said ozempic is not covered through insurance. Ozempic, trulicity, and Mounjaro are technically suppose to be used for type 2 diabetes so unless you have that ICD-10 it’ll be 98% more likely to be denied since insurance can argue hey you have these other issues, but not the type 2 I’ve been on Ozempic and Metformin for five weeks started on . I had very little notice so wasn’t able to titrate it down for long. Hope that helps! My doctor prescribed me Wegovy for weight loss, and in CVS they are out of stock on those injections. 5 mg a week, 1. They should have your blood work and an understanding of your medications and be helpful to submit a PA request/appeal. Ozempic Denied for Type 2 Diabetes I was on it in the past, metformin doesn’t work for me, and Ozempic is listed as the preferred medication and as a preventative treatment if my A1C is 5. This is the typical experience. I have scoured the internet and see that even with an appeal, they will continue to deny because I don’t have type 2 diabetes. With a prior-authorization from my doctor, I was able to get my first round of ozempic at . According to data published in the Wall Street Journal, only 17. jjgh hhkgxt jot xbfinyeg wcaxtxtf qflutcz dvvhyyxln ybw ezwm qlijep