Prescription for Wegovy but $1500?!?!

[Anonymous]

I have Cigna and they covered it for me, but did need PA. The kicker is that there’s such a shortage, it’s been a month and I can’t get the Rx filled.

[Anonymous]

Anonymous wrote:I have Cigna and they covered it for me, but did need PA. The kicker is that there’s such a shortage, it’s been a month and I can’t get the Rx filled.

Ok thank you. Do you have prediabetes or any other condition?

[Anonymous]

You might be able to get Ozempic covered with a pre authorization for pcos or metabolic disorder diagnosis but yeah many insurance companies aren’t covering this willy nilly.

[Anonymous]

I have Cigna and it was covered for me, but your doctor needs to know how to properly write the prescription in order to get it covered.

[Anonymous]

Just a note that one Cigna plan covering it doesn’t mean another one would. I don’t think Wegovy ( as specified for weight loss) is on Cigna’s national formularies, but it is possible an individual employer has directed Cigna to add it for their employees.

[Anonymous]

Anonymous wrote:All very helpful thank you! My A1C is 5.2 so not prediabetic at this time. I know that it’s common for PCOS so will watch out for that.

-OP

This is likely a PA issue as others have stated. But I have PCOS and my A1C is also not prediabetic, I also have great fasting glucose levels. The trouble is when I actually eat. An insulin resistance test or glucose tolerance test is actually more effective for most people, it is just more time consuming and expensive.

[Anonymous]

Anonymous wrote:

Anonymous wrote:All very helpful thank you! My A1C is 5.2 so not prediabetic at this time. I know that it’s common for PCOS so will watch out for that.

-OP

This is likely a PA issue as others have stated. But I have PCOS and my A1C is also not prediabetic, I also have great fasting glucose levels. The trouble is when I actually eat. An insulin resistance test or glucose tolerance test is actually more effective for most people, it is just more time consuming and expensive.

True but wouldn’t that drive the A1C higher as time passes?

My son has Type1 so I’m all to familiar with blood sugar monitoring.

[Anonymous]

I’m on Saxenda which my insurance covered for weight loss. BMI is 30 but not diabetic or prediabetic. It’s only Day 2 but wow. It really curbs the hunger pangs.

[Anonymous]

It’s in the insurance company’s interest to reduce everyone’s weight. I hope this becomes easier to get.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I have Cigna and they covered it for me, but did need PA. The kicker is that there’s such a shortage, it’s been a month and I can’t get the Rx filled.

Ok thank you. Do you have prediabetes or any other condition?

Nope — Just fat with high (but controlled) BP. No prediabetes.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:All very helpful thank you! My A1C is 5.2 so not prediabetic at this time. I know that it’s common for PCOS so will watch out for that.

-OP

This is likely a PA issue as others have stated. But I have PCOS and my A1C is also not prediabetic, I also have great fasting glucose levels. The trouble is when I actually eat. An insulin resistance test or glucose tolerance test is actually more effective for most people, it is just more time consuming and expensive.

True but wouldn’t that drive the A1C higher as time passes?

My son has Type1 so I’m all to familiar with blood sugar monitoring.

Insulin resistance is when cells in your muscles, fat, and liver don’t respond well to insulin and can’t easily take up glucose from your blood. As a result, your pancreas makes more insulin to help glucose enter your cells. As long as your pancreas can make enough insulin to overcome your cells’ weak response to insulin, your blood glucose levels will stay in the healthy range.

So what ends up happening is it like every time you eat your pancreas is producing more and more insulin to get it into your cells but then you run the risk of you know your blood sugar dropping too low which is what happens with me like the 3-hour glucose tolerance test for me takes me all the down down to like low 40s 50s by the end of 3 hours. So you can imagine by the end of like 2 to 3 hours I'm not feeling good and my body is sending all the signals to ingest more glucose because my blood sugar is dropping.

It's a really disordered feedback loop.

Glp 1 agonistso help with not only your pancreas response but also they lead you to feeling more satiety. And it helps control blood sugar levels both from going too high but also going to low. A lot of the times with insulin resistance because of the lack of receptability of the cells your body is having to produce and produce and produce to get the one of the fact but then it might over correct.
Again it's a little different from my understanding from diabetes because the issue is not with your pancreas being able to produce insulin it's actually within your cells being able to uptake glucose.

[Anonymous]

Anonymous wrote:

Anonymous wrote: Some (most?) insurance plans have a specific exemption for weight loss meds. My otherwise fantastic Cigna plan does.

but they arent exempted for non-weight loss purposes I assume? PCOS is a metabolic disorder.

-not OP

Correct - those exemptions are usually tied to a specific ICD Code. But if you need a PA, there are very specific ICD codes they will accept to cover it. For example, for Ozempic for me, there’s a weight loss exemption. You need Type 2 diabetes to get it covered. So getting it written for PCOS still won’t help. Form what I understand, this is super common but worth trying on your own. Note that a lot of insurance will do 1-2 courtesy fills while you seek a PA so the fact that the first month or two is covered doesn’t necessarily mean it worked.