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

[Anonymous]

Have your doctor appeal. They may need to prescribe Metformin. Get a prescription and tell your doctor after a week or so of “taking” it that you can’t bear the stomach pains. That might be enough along with the prediabetic numbers to get it approved.

[Anonymous]

Anonymous wrote:it's a private insurance through employer (Cigna + express scripts).

Google Cigna Wegovy/ozempic pre authorization. I have Cigna and had to go through this process. There are 5 or 6 criteria that have to be met.

You only need to try metformin if your plan requires step therapy. Mine did not.

The PAs for this are time consuming and a pain in the …. I went through each criteria line by line and wrote out the response for my dr to submit.

[Anonymous]

You need to meet the criteria for 1A—Initial Therapy


https://static.cigna.com/assets/chcp/pdf/coveragePolicies/cnf/cnf_684_coveragepositioncriteria_weight_loss_glp1_agonists_pa.pdf

[Anonymous]

thank you! I actually Google this last night but how do I prove I tried to lose weight previously? Do they really think this first occurred to me at age 56?

[Anonymous]

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.

[Anonymous]

Anonymous wrote:thank you! I actually Google this last night but how do I prove I tried to lose weight previously? Do they really think this first occurred to me at age 56?

You talk to you doctor about it. Tell them that you’ve done Weight Watchers on and off for 25 years. You don’t have to “prove” it.

[Anonymous]

Anonymous wrote:thank you! I actually Google this last night but how do I prove I tried to lose weight previously? Do they really think this first occurred to me at age 56?

Yes?

[Anonymous]

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.

A diet for 40 years? What do you think happens when you lose 50 and stop the medicine? Maintaining weight loss is the real diet. Or do you plan on being on it forever?

[Anonymous]

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.

Dude. It will cost the insurance company way more down the road to treat sicker people instead of helping them lose weight earlier and preventing lifestyle diseases in the first place. Do you tell someone whom severely depressed to just try running first before getting meds? Sure, running might be good, but if they need the meds they need the meds.

[Anonymous]

Can you get Wegovy? It's for weight loss, while Ozempic is for diabetes.

[Anonymous]

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.

See an endocrinologist. Expect to spend six months on Metformin first and be told to lose 20 before they will consider putting you on a medication that costs thousands

Go eat rocks. I’m not the PP but you are seriously not well.

[Anonymous]

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.

A diet for 40 years? What do you think happens when you lose 50 and stop the medicine? Maintaining weight loss is the real diet. Or do you plan on being on it forever?

Dude, go worry about something that actually concerns you. This doesn’t. jFc

[Anonymous]

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.

A diet for 40 years? What do you think happens when you lose 50 and stop the medicine? Maintaining weight loss is the real diet. Or do you plan on being on it forever?

why not?

[Anonymous]

Anonymous wrote:

Anonymous wrote:thank you! I actually Google this last night but how do I prove I tried to lose weight previously? Do they really think this first occurred to me at age 56?

You talk to you doctor about it. Tell them that you’ve done Weight Watchers on and off for 25 years. You don’t have to “prove” it.

the doctor knows this. he is on board.

[Anonymous]

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.

A diet for 40 years? What do you think happens when you lose 50 and stop the medicine? Maintaining weight loss is the real diet. Or do you plan on being on it forever?

it is considered a chronic medication--so yes, people should plan to be on it forever