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

[Anonymous]

Anonymous wrote: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/

My guess is because it isn’t a magical weight loss drug like the others

[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.

I’m so sick of posts like this. The implication is that is just really easy, and if you struggle and don’t actually lose weight, it’s a moral failing on your part. If you’ve ready anything about this drug, you’d know that it’s being looked at as a way to treat addiction. Open up your mind to the possibility that some people are just wired differently. They process food and experience hunger differently than you.

Holy overreaction, Batman. OP said diets have only made her gain more, which is common and something we've known for a long time - that diets don't work. Restricting doesn't work. Lowering cabs doesn't work.

Being fat and overweight is a choice. Having heart disease is not a choice.

[Anonymous]

Anonymous wrote:

Anonymous wrote: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/

My guess is because it isn’t a magical weight loss drug like the others

Metformin does help a lot of people lose weight though. I work at an Ophthalmology office and we see a lot of people for diabetic eye exams. I'm a tech and when taking their history so many people have told me how Metformin has changed their lives and helped them lose weight and get their A1c numbers under control.

https://www.everydayhealth.com/type-2-diabetes/treatment/metformin-weight-loss-truth-behind-side-effect/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6520185/

[Anonymous]

Anonymous wrote:

Anonymous wrote:

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 just pay for it yourself instead of trying to find a way to lie to insurance company.

I will pay for it but since I payed tens of thousands of dollars to insurance over years why not try to get some benefit from it once in a blue moon?

also, when did I lie to insurance? it is a fact that I am obese and that dieting has made me more obese. my blood work is what it is.

Excuses are the clever man's way of lying. We are all as smart as you are can see through your cleverness. You know that is not how insurance works, the goal is not to "use it" like it is expirable annual leave at work.

Ozempic is not prescribed for obesity, so you just told on yourself.

please stop making this into some kind of morality play. there is nothing moral about denying medicine to people who need them or making them jump over a bunch of meaningless hoops.

and yes, while at the technical level insurance does not work this way, on the moral level it is certainly not wrong to push to get a medicine my two doctors believe i need from an insurance i paid tens if not hundreds of thousand of dollars into.

the facts of my case are the following: i have prescriptions for both wegovy and ozempic. this is because i am obese and also, as i already put it, marginally pre-diabetic - outside of normal range but by only a very small number. ozempic coverage has been denied by my insurance and i don't know why yet. i am looking at my options. i have gotten several good suggestions for which I am very grateful.

is there any way to save on out of pocket costs, however slightly? i found some online coupons according to which I can get ozempic for around $900?

If you didn't want this to be a morality play, you wouldn't be giving all of these "reasons" why are not asking to break rules. You would just straight up say "how can I get around the rules" with pride.

NP. You need to just zip it. She isn’t breaking the rules. You don’t know what the f you are talking about. Wegovy is for obesity. OP is obese. A doctor prescribed Ozempic for off-label treatment. Perfectly appropriate. So can you stop harassing OP now snd seek some help? Signed - former health care fraud prosecutor.

[Anonymous]

Anonymous wrote: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/

Probably because metformin is weight neutral.

[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?

Wow, I can't believe your admitting you just don't *want* to exercise.

[Anonymous]

Anonymous wrote:

Anonymous wrote:oh, and if my insurance doesn't cover it, i will pay for it out of pocket. and for some reason, this will be more palatable to you - because i will be punishing me, even though you don't know me and it has nothing to do with you.

No one is “punishing” you for being fat — drop that victimhood mentality.

People are reacting to your attitude and sense of entitlement and determination to find short cuts.

And yes, this has to do with us. It’s people with the mentality you are displaying that are causing shortages of this medication for those of us who legitimately qualify to receive it. And didn’t take short cuts.

NP. You took a short cut when you let yourself go, gained weight, was out of shape and got diabetes. Unless you were a born diabetic which I highly doubt. Happy now?

[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?

They are the exact same drug. It’s a distinction without a difference, unless you are an insurance company driven by profit. Why is that confusing?

[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.

I’m so sick of posts like this. The implication is that is just really easy, and if you struggle and don’t actually lose weight, it’s a moral failing on your part. If you’ve ready anything about this drug, you’d know that it’s being looked at as a way to treat addiction. Open up your mind to the possibility that some people are just wired differently. They process food and experience hunger differently than you.

Holy overreaction, Batman. OP said diets have only made her gain more, which is common and something we've known for a long time - that diets don't work. Restricting doesn't work. Lowering cabs doesn't work.

Being fat and overweight is a choice. Having heart disease is not a choice.

It is when it is caused by being far and out of shape, which accounts for about 99 percent of cardiac problems. People in this thread and literally the dumbest group yet on DCUM.

[Anonymous]

OP your insurance may just not cover it unless you are diabetic. Mine doesn’t and I was in the prediabetic range. Many don’t. I pay out of pocket through my doctors office or through Amazon Pharmacy.

[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?

Wow, I can't believe your admitting you just don't *want* to exercise.

All these threads end up the same if the posters are truthful. They don’t want to do the work and it’s “too hard.” This is so because at a population level people are conditioned now to expect life to be way too easy. Easy times, weak people and all that.

[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.

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?

Wow, I can't believe your admitting you just don't *want* to exercise.

All these threads end up the same if the posters are truthful. They don’t want to do the work and it’s “too hard.” This is so because at a population level people are conditioned now to expect life to be way too easy. Easy times, weak people and all that.

DP but the thing that surprises me is these drugs have side effects that sound pretty cumbersome to deal with. The hassle of getting them first of all, or finding them in stock now that there’s a Wegovy shortage. Dealing with injections and the loss of muscle mass and other various things people have reported. And I know working out isn’t fun if you’re overweight and it’s tough and you’re viewing it as punishment for being fat vs. taking advantage of your body’s ability to move and play, and it isn’t the main factor of weight loss, but don’t you still need to do it even if on semaglutides? I don’t think most doctors would say yeah, take this and you never need to work out again!

[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.

I’m so sick of posts like this. The implication is that is just really easy, and if you struggle and don’t actually lose weight, it’s a moral failing on your part. If you’ve ready anything about this drug, you’d know that it’s being looked at as a way to treat addiction. Open up your mind to the possibility that some people are just wired differently. They process food and experience hunger differently than you.

Holy overreaction, Batman. OP said diets have only made her gain more, which is common and something we've known for a long time - that diets don't work. Restricting doesn't work. Lowering cabs doesn't work.

Being fat and overweight is a choice. Having heart disease is not a choice.

If it really is, then being stupid is also a choice. Thanks for being the example for that.

https://www.healthline.com/nutrition/9-reasons-obesity-is-not-a-choice#:~:text=When%20it%20comes%20to%20obesity,weight%20if%20you%20choose%20to.

https://www.ualberta.ca/medicine/news/2021/03/obesity-a-chronic-disease,-not-a-choice.html#:~:text=Obesity%20is%20a%20complex%20chronic%20disease&text=Far%20from%20being%20a%20condition,us%20from%20losing%20body%20weight.

https://www.bbc.com/news/health-49795808.amp

[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.

I’m so sick of posts like this. The implication is that is just really easy, and if you struggle and don’t actually lose weight, it’s a moral failing on your part. If you’ve ready anything about this drug, you’d know that it’s being looked at as a way to treat addiction. Open up your mind to the possibility that some people are just wired differently. They process food and experience hunger differently than you.

Holy overreaction, Batman. OP said diets have only made her gain more, which is common and something we've known for a long time - that diets don't work. Restricting doesn't work. Lowering cabs doesn't work.

Being fat and overweight is a choice. Having heart disease is not a choice.

If it really is, then being stupid is also a choice. Thanks for being the example for that.

https://www.healthline.com/nutrition/9-reasons-obesity-is-not-a-choice#:~:text=When%20it%20comes%20to%20obesity,weight%20if%20you%20choose%20to.

https://www.ualberta.ca/medicine/news/2021/03/obesity-a-chronic-disease,-not-a-choice.html#:~:text=Obesity%20is%20a%20complex%20chronic%20disease&text=Far%20from%20being%20a%20condition,us%20from%20losing%20body%20weight.

https://www.bbc.com/news/health-49795808.amp

The minute somebody tells you something is “multi-variable” “complicated” or any other nonsense, you know they are full of condensed milk. The vast majority of obesity is within the control of those who are obese.

150 years ago, these people wouldn’t even make it past the age of 40. Now we get the distinct pleasure of listening to them belly ache as if the universe inflicted some uncontrollable pestilence on them while they refuse to exercise and stop buying garbage in the middle of the grocery story.

[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.

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?

Wow, I can't believe your admitting you just don't *want* to exercise.

All these threads end up the same if the posters are truthful. They don’t want to do the work and it’s “too hard.” This is so because at a population level people are conditioned now to expect life to be way too easy. Easy times, weak people and all that.

DP but the thing that surprises me is these drugs have side effects that sound pretty cumbersome to deal with. The hassle of getting them first of all, or finding them in stock now that there’s a Wegovy shortage. Dealing with injections and the loss of muscle mass and other various things people have reported. And I know working out isn’t fun if you’re overweight and it’s tough and you’re viewing it as punishment for being fat vs. taking advantage of your body’s ability to move and play, and it isn’t the main factor of weight loss, but don’t you still need to do it even if on semaglutides? I don’t think most doctors would say yeah, take this and you never need to work out again!

It’s remarkable in the truest meaning of that word.