Express Scripts denied pre-authorization for Ozempic. What to do now?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:What, pray tell, is “marginally pre-diabetic?”

If you want to lose 50, eat less and move more and cut down on carbs. That will do a lot to help your glucose too. You don’t need Ozempic.

my A1c is outside the normal range, but only a little.

yes, I do need Ozempic. I have been on a diet for the past 40 years.

Ozempic isn’t for prediabetes. But op probably already knows this. Metformin is for prediabetes.

i don't know what prediabetes is, technically, and i am unfamiliar with metformin. i pretty sure i don't want to take it.

Lol didn’t you say you had marginal diabetes? That would be called prediabetes. What is your a1c? I got ozempic because mine was 10.2

I had gestational diabetes with my last pregnancy which makes one a likely candidate to develop diabetes as they get older. For the next 10 years, I worked like a dog to stay fit—did Weight watchers, lifted weights, ran a marathon. And then I turned 50. I tried and tried to lose weight—again, did Weight Watchers religiously and worked out. My 54-year old body was not dropping any of the the 30lbs I needed to lose. And my A1C was 5.8 (pre-diabetic)

I was prescribed Ozempic and have been taking it for a year. I pay $25/month. Lost 25lbs and A1C is now in normal range. I feel great and have no issue with taking this drug forever.

OP-I hope you can get this covered. It’s a great drug. I’ve have minimal side effects. Fatigue is the worst part. The best part is that the “food noise” is gone.

You are not the right kind of candidate for Ozempic. Shame on you.

Who is the “right” Ozempic candidate, exactly?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Go to a real doctor?

I have been to two "real doctors". one prescribed ozempic and the other wegovy. thank you for your concern.

Then why aren’t you trying Wegovy? Because you have to pay? You’ll have to pay for the ozempic too. Thousands.

OMG OMG aren't you happy that i will be punished for being fat. i will pay thousands THOUSANDS!!

Mine is $15/month because I have diabetes. You don’t.

NP. For someone who gave himself type Ii diabetes mellitus through, cumulatively, years of poor health choices under their control…. You are confusingly smug about the OP’s BMI. It’s entirely unclear why you would feel superior to OP? I mean, your attempts at diet modification were so abysmal (or absent) that you killed your pancreas.

OP’s A1c tells us her pancreas isn’t as jacked up as yours is, by your own poor choices over a lifetime.

Congrats?

In the culpability olympics, OP > you at this point on the timeline. If my insurance premiums must increase, I’d rather they benefit her over you. As it is, I’m sure I’m already indirectly paying for your DM-related glaucoma, erectile dysfunction, CKD meds and maybe foot care amd cardiac meds.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:What, pray tell, is “marginally pre-diabetic?”

If you want to lose 50, eat less and move more and cut down on carbs. That will do a lot to help your glucose too. You don’t need Ozempic.

my A1c is outside the normal range, but only a little.

yes, I do need Ozempic. I have been on a diet for the past 40 years.

Ozempic isn’t for prediabetes. But op probably already knows this. Metformin is for prediabetes.

i don't know what prediabetes is, technically, and i am unfamiliar with metformin. i pretty sure i don't want to take it.

DP here - In your initial post, you said you were "marginally pre-diabetic" and have repeated that several times. But now you don't know what prediabetes is?

Look, OP, it's clear you want Ozempic to lose weight, and are looking for a way to make that happen. Just own it.

i am owning it from the very first post. i am telling you what my doctor, who gave me a prescription for ozempic, told me, and what her justification was. if i can milk that diagnosis to get ozempic, i will do so. yes, i want to take advantage of these new medicine to lose weight, like a gazillion of other people.

i am also prescribed wegovy by a different doctor in the same practice. i am still waiting for approval there.

It's not about punishing you. It's increasing irritation with people like you who try to game the system, up to and including committing outright insurance fraud. We know, we know, you're special, and you *deserve* for your insurance to pay thousands of dollars to cover this drug even though you don't meet the established criteria. But you're really not different than thousands of other people, despite what you think, or have been told.

what are you talking about? i meet all the cigna criteria for wegovy. you misread the insurance criteria, then accused me of insurance fraud because... you want me to lose the weight the hard instead of an easy way.

rather than lecturing me on food and exercise and insurance policies, you need to reflect on why you are so invested in having fat people punished.

First, I'm not that person. Second, the bulk of this thread is you whining about not getting Ozempic - it's right there in the title. You apparently don't meet that criteria, as you yourself state.

Third, persisting with this "punishing fat people" nonsense isn't a great look.

[Anonymous]

NP: I’ve lost more weight through diet and exercise than my Ozempic co-worker. I’m also 61, insulin resistant, pre-diabetic A1C (right at the top of the cutofff), body fat from 4 pregnancies, fatty liver/metabolic syndrome, bmi started off at 30.

What I did: started following a “reverse your diabetes” group. Carbs are very low and NO added sugar. Lots of raw veggies. My weight is dropping slowly but steadily. I’m now 11 pounds away from having a healthy bmi below 25. My most recent blood work looks amazing…constant cholesterol highs (for years!) well over 200 are now at 150. By not spiking my blood sugar I don’t get the highs and lows that used to leave me craving and foraging for snacks. I utilize IF too.

[Anonymous]

For op, this sounds ridiculous but go on tik tok and listen to all the creators that discuss ways to get approval for the drugs. They will know which drugs require what type of pre approval. That will be the most helpful. I wish you luck in the effort to take care of your health.

[Anonymous]

Anonymous wrote:Wegovy, yes. Ozempic, no. Hence why you were denied. Try to push through the Wegovy RX you got.

Wegovy is back ordered. Ozempic is the same drug and the logical substitute but insurance companies never miss an opportunity to deny a claim.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:What, pray tell, is “marginally pre-diabetic?”

If you want to lose 50, eat less and move more and cut down on carbs. That will do a lot to help your glucose too. You don’t need Ozempic.

my A1c is outside the normal range, but only a little.

yes, I do need Ozempic. I have been on a diet for the past 40 years.

Ozempic isn’t for prediabetes. But op probably already knows this. Metformin is for prediabetes.

i don't know what prediabetes is, technically, and i am unfamiliar with metformin. i pretty sure i don't want to take it.

Lol didn’t you say you had marginal diabetes? That would be called prediabetes. What is your a1c? I got ozempic because mine was 10.2

I had gestational diabetes with my last pregnancy which makes one a likely candidate to develop diabetes as they get older. For the next 10 years, I worked like a dog to stay fit—did Weight watchers, lifted weights, ran a marathon. And then I turned 50. I tried and tried to lose weight—again, did Weight Watchers religiously and worked out. My 54-year old body was not dropping any of the the 30lbs I needed to lose. And my A1C was 5.8 (pre-diabetic)

I was prescribed Ozempic and have been taking it for a year. I pay $25/month. Lost 25lbs and A1C is now in normal range. I feel great and have no issue with taking this drug forever.

OP-I hope you can get this covered. It’s a great drug. I’ve have minimal side effects. Fatigue is the worst part. The best part is that the “food noise” is gone.

You are not the right kind of candidate for Ozempic. Shame on you.

you are insane.

Ozempic is for diabetics. OP needs Wegovy, which is for weight loss. Why is that confusing?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:What, pray tell, is “marginally pre-diabetic?”

If you want to lose 50, eat less and move more and cut down on carbs. That will do a lot to help your glucose too. You don’t need Ozempic.

my A1c is outside the normal range, but only a little.

yes, I do need Ozempic. I have been on a diet for the past 40 years.

Ozempic isn’t for prediabetes. But op probably already knows this. Metformin is for prediabetes.

i don't know what prediabetes is, technically, and i am unfamiliar with metformin. i pretty sure i don't want to take it.

Lol didn’t you say you had marginal diabetes? That would be called prediabetes. What is your a1c? I got ozempic because mine was 10.2

I had gestational diabetes with my last pregnancy which makes one a likely candidate to develop diabetes as they get older. For the next 10 years, I worked like a dog to stay fit—did Weight watchers, lifted weights, ran a marathon. And then I turned 50. I tried and tried to lose weight—again, did Weight Watchers religiously and worked out. My 54-year old body was not dropping any of the the 30lbs I needed to lose. And my A1C was 5.8 (pre-diabetic)

I was prescribed Ozempic and have been taking it for a year. I pay $25/month. Lost 25lbs and A1C is now in normal range. I feel great and have no issue with taking this drug forever.

OP-I hope you can get this covered. It’s a great drug. I’ve have minimal side effects. Fatigue is the worst part. The best part is that the “food noise” is gone.

You are not the right kind of candidate for Ozempic. Shame on you.

you are insane.

Ozempic is for diabetics. OP needs Wegovy, which is for weight loss. Why is that confusing?

this is not about NP but another PP who was pre diabetic, used ozempic for some time and with great success. yet another PP is bitter about it.

some of you are either extremely anal about ozempic and wegovy, which is kind of weird, or are using this as an excuse to vent that omg now some people will be able to lose weight without putting in the effort you want them to put in.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:What, pray tell, is “marginally pre-diabetic?”

If you want to lose 50, eat less and move more and cut down on carbs. That will do a lot to help your glucose too. You don’t need Ozempic.

my A1c is outside the normal range, but only a little.

yes, I do need Ozempic. I have been on a diet for the past 40 years.

Stop doing diets. Eat a little less (of everything), and move more. Move every single day.

it's amazing that you are confident you know what my habits are.

i make more than 10k steps every day. i can't eat little bit of everything, not long term. i my on intermittent fasting right now, which has worked best for my, historically, and i am waking multiple times every night with hunger pangs.

Why can't you eat a little bit of everything long term?

Respectfully, walking and 10k steps don't do much - it's quality, not quantity. 5k steps on stairs or hills, or adding in weights (that are challenging) will do more than simple walking.

because i tried to, many times, and i failed.

and i never said walking 10k was much. somebody said "get up and start moving" and wrote this to let them know that i am moving. but i am not going to run or to go to the gym. i tried all this, i hade 4 different trainers. they were great, and i learned a lot. many people grow to like exercise but not me. i hate and i don't want to do it.

so if this is going to make some of you feel better, which, weirdly, seems like it will, i have put a lot of sweat equity into this already. i spent years feeling deprived from dieting. now, it seems like there is an easier way. i am old, i am still dealing with kids, and i am tired from being hungry and deprived with nothing to show for it. why are you so set against me losing some weight more easily?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:What, pray tell, is “marginally pre-diabetic?”

If you want to lose 50, eat less and move more and cut down on carbs. That will do a lot to help your glucose too. You don’t need Ozempic.

my A1c is outside the normal range, but only a little.

yes, I do need Ozempic. I have been on a diet for the past 40 years.

Stop doing diets. Eat a little less (of everything), and move more. Move every single day.

it's amazing that you are confident you know what my habits are.

i make more than 10k steps every day. i can't eat little bit of everything, not long term. i my on intermittent fasting right now, which has worked best for my, historically, and i am waking multiple times every night with hunger pangs.

Why can't you eat a little bit of everything long term?

Respectfully, walking and 10k steps don't do much - it's quality, not quantity. 5k steps on stairs or hills, or adding in weights (that are challenging) will do more than simple walking.

because i tried to, many times, and i failed.

and i never said walking 10k was much. somebody said "get up and start moving" and wrote this to let them know that i am moving. but i am not going to run or to go to the gym. i tried all this, i hade 4 different trainers. they were great, and i learned a lot. many people grow to like exercise but not me. i hate and i don't want to do it.

so if this is going to make some of you feel better, which, weirdly, seems like it will, i have put a lot of sweat equity into this already. i spent years feeling deprived from dieting. now, it seems like there is an easier way. i am old, i am still dealing with kids, and i am tired from being hungry and deprived with nothing to show for it. why are you so set against me losing some weight more easily?

Lol you are a trip. Being an adult is doing things you hate but have to do. I guess we should all just stop doing anything even slightly unfun.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:What, pray tell, is “marginally pre-diabetic?”

If you want to lose 50, eat less and move more and cut down on carbs. That will do a lot to help your glucose too. You don’t need Ozempic.

my A1c is outside the normal range, but only a little.

yes, I do need Ozempic. I have been on a diet for the past 40 years.

Stop doing diets. Eat a little less (of everything), and move more. Move every single day.

it's amazing that you are confident you know what my habits are.

i make more than 10k steps every day. i can't eat little bit of everything, not long term. i my on intermittent fasting right now, which has worked best for my, historically, and i am waking multiple times every night with hunger pangs.

Why can't you eat a little bit of everything long term?

Respectfully, walking and 10k steps don't do much - it's quality, not quantity. 5k steps on stairs or hills, or adding in weights (that are challenging) will do more than simple walking.

because i tried to, many times, and i failed.

and i never said walking 10k was much. somebody said "get up and start moving" and wrote this to let them know that i am moving. but i am not going to run or to go to the gym. i tried all this, i hade 4 different trainers. they were great, and i learned a lot. many people grow to like exercise but not me. i hate and i don't want to do it.

so if this is going to make some of you feel better, which, weirdly, seems like it will, i have put a lot of sweat equity into this already. i spent years feeling deprived from dieting. now, it seems like there is an easier way. i am old, i am still dealing with kids, and i am tired from being hungry and deprived with nothing to show for it. why are you so set against me losing some weight more easily?

Good grief. Enough with the victim complex. No one is opposed to you losing weight, just to your insurance paying for a diabetes drug to help you do it (especially when one of your excuses, when asked about exercise, is "I don't wanna!" You sound like a child.)

[Anonymous]

wegovy is not a diabetes drug, ok? my insurance covers it. i meet the requirements. so what is your problem?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:What, pray tell, is “marginally pre-diabetic?”

If you want to lose 50, eat less and move more and cut down on carbs. That will do a lot to help your glucose too. You don’t need Ozempic.

my A1c is outside the normal range, but only a little.

yes, I do need Ozempic. I have been on a diet for the past 40 years.

Stop doing diets. Eat a little less (of everything), and move more. Move every single day.

it's amazing that you are confident you know what my habits are.

i make more than 10k steps every day. i can't eat little bit of everything, not long term. i my on intermittent fasting right now, which has worked best for my, historically, and i am waking multiple times every night with hunger pangs.

Why can't you eat a little bit of everything long term?

Respectfully, walking and 10k steps don't do much - it's quality, not quantity. 5k steps on stairs or hills, or adding in weights (that are challenging) will do more than simple walking.

because i tried to, many times, and i failed.

and i never said walking 10k was much. somebody said "get up and start moving" and wrote this to let them know that i am moving. but i am not going to run or to go to the gym. i tried all this, i hade 4 different trainers. they were great, and i learned a lot. many people grow to like exercise but not me. i hate and i don't want to do it.

so if this is going to make some of you feel better, which, weirdly, seems like it will, i have put a lot of sweat equity into this already. i spent years feeling deprived from dieting. now, it seems like there is an easier way. i am old, i am still dealing with kids, and i am tired from being hungry and deprived with nothing to show for it. why are you so set against me losing some weight more easily?

Lol you are a trip. Being an adult is doing things you hate but have to do. I guess we should all just stop doing anything even slightly unfun.

it's also finding if i actually have to them, or is there an easier way. it seems like there is!

[Anonymous]

Anonymous wrote:wegovy is not a diabetes drug, ok? my insurance covers it. i meet the requirements. so what is your problem?

Once again, you complete nitwit, read the title of your own damn post. Take the Wegovy - no one cares. But that's not what you're complaining about.

[Anonymous]

Why is everyone against trying Metformin first? It's cheap and works great for a lot of people. There also seem to be studies coming out all the time talking about all the health benefits you gain from taking it. I also don't think there is a shortage for it right now.

https://fortune.com/well/2023/05/04/metformin-anti-aging-longevity-risks-side-effects/