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

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Op no one cares if you get Wegovy, people are reacting to you wanting ozempic and for insurance to pay for it, because as you said previously, you’ve paid a lot to insurance over the years and want something back. THAT is what people are reacting to, because you don’t qualify for ozempic and you are trying to take diabetes medication away from diabetics, by contributing to the shortages. Get Wegovy and call it a day.

if this is true, it's completely ridiculous. it's a formality - the medicine is the same, and my doctor for some reason put ozempic.

people were complaining that i want my insurance to cover medicine that two doctors prescribed for me. i find that ridiculous.

Wah Wah Wah go complain to insurance, they are the ones who are denying your claims, not anonymous strangers on the internet. You don’t qualify, there’s rules, and you’re not special.

Insurance PR types seem to hang out here, so this is as good a place to complain as any.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:People, including Jeff who told us to MYOB on the front page of DCUM, seem to forget who pays for insurance. The money doesn't appear out of thin air, it's funded by the other people on your insurance plan. So OP getting her weight loss medicine covered by insurance means the rest of us have to pay for it.

You're being penny wise and pound foolish. The medicine costs less than the complications that arise when weight loss is not addressed. Paying a little now saves the insurance pool a lot later.

Apparently, the actuarial analysis used by the insurance companies, which I'm guessing is more sophisticated than your guess, disagrees. Which do you think is correct?

People switch insurance carriers many times in their lives. They don't care about long term health, only this quarter's profits.

That's why they're so unnerved that so many people are looking at formularies before they renew or switch.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Insurance companies decide what is covered. Not your doctor, OP. You can get a prescription, no one is stopping you. But you won’t have it covered so stop complaining, or else eat more bad food so you get full blown diabetes and then it will be covered.

insurance company does cover both ozempic and wegovy. so they already decided they would do it.

and my doctors think i need them. it's weird to me that there the company needs to make additional approval to cover the medicine they already decided to cover. if they don't want to cover wegovy, fine. but why second guess my doctor? why would they know better what i need?

Because they know people would drop them if they took Wegovy off the formulary.

[Anonymous]

Can the person spouting lies about there not being a shortage please shut their pie hole? The drug shortage website clearly lists the shortage, so stop being selfish and trying to justify why you need this drug for vanity reasons.

[Anonymous]

There’s a woman I know on wegovy, lost about 90 lbs and looks disastrous. Saggy facial skin that has fallen to her droopy neck. Droopy as in her neck sags 3” off her jawline with folds and crinkles! Thin skin on arms hangs 5”. Wrinkled skin at thighs hangs below her knees. Her butt looks like she wears a diaper because there’s so much excess skin. She has no muscle tone and I swear her skin moves when the wind blows. And she’s losing her hair. She aged at least 10 years in a fraction of one. And I think she knows it because she’s been piling on the make up. And that’s only what I can see, who knows what her mid section looks like. Maybe I’m too vain but who wants to look worse after weight loss? Op, think long and hard.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:People, including Jeff who told us to MYOB on the front page of DCUM, seem to forget who pays for insurance. The money doesn't appear out of thin air, it's funded by the other people on your insurance plan. So OP getting her weight loss medicine covered by insurance means the rest of us have to pay for it.

You're being penny wise and pound foolish. The medicine costs less than the complications that arise when weight loss is not addressed. Paying a little now saves the insurance pool a lot later.

Apparently, the actuarial analysis used by the insurance companies, which I'm guessing is more sophisticated than your guess, disagrees. Which do you think is correct?

People switch insurance carriers many times in their lives. They don't care about long term health, only this quarter's profits.

That's why they're so unnerved that so many people are looking at formularies before they renew or switch.

LOL. You have an actual fantasy life, don’t you.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Insurance companies decide what is covered. Not your doctor, OP. You can get a prescription, no one is stopping you. But you won’t have it covered so stop complaining, or else eat more bad food so you get full blown diabetes and then it will be covered.

insurance company does cover both ozempic and wegovy. so they already decided they would do it.

and my doctors think i need them. it's weird to me that there the company needs to make additional approval to cover the medicine they already decided to cover. if they don't want to cover wegovy, fine. but why second guess my doctor? why would they know better what i need?

Because they know people would drop them if they took Wegovy off the formulary.

Most people have insurance through their employer so this idea that individuals impulsively drop carriers is a fiction. There’s only one open enrollment season anyway.

[Anonymous]

Anonymous wrote:There’s a woman I know on wegovy, lost about 90 lbs and looks disastrous. Saggy facial skin that has fallen to her droopy neck. Droopy as in her neck sags 3” off her jawline with folds and crinkles! Thin skin on arms hangs 5”. Wrinkled skin at thighs hangs below her knees. Her butt looks like she wears a diaper because there’s so much excess skin. She has no muscle tone and I swear her skin moves when the wind blows. And she’s losing her hair. She aged at least 10 years in a fraction of one. And I think she knows it because she’s been piling on the make up. And that’s only what I can see, who knows what her mid section looks like. Maybe I’m too vain but who wants to look worse after weight loss? Op, think long and hard.

Damn. No one can win with you. The choices are for your friend to either stay 90lbs overweight or to be skinny and ugly.

[Anonymous]

Anonymous wrote:There’s a woman I know on wegovy, lost about 90 lbs and looks disastrous. Saggy facial skin that has fallen to her droopy neck. Droopy as in her neck sags 3” off her jawline with folds and crinkles! Thin skin on arms hangs 5”. Wrinkled skin at thighs hangs below her knees. Her butt looks like she wears a diaper because there’s so much excess skin. She has no muscle tone and I swear her skin moves when the wind blows. And she’s losing her hair. She aged at least 10 years in a fraction of one. And I think she knows it because she’s been piling on the make up. And that’s only what I can see, who knows what her mid section looks like. Maybe I’m too vain but who wants to look worse after weight loss? Op, think long and hard.

Imagine writing this and spending any time worrying about some other woman!!

[Anonymous]

There are some pretty awful side effects with this class of drugs. The ones I am most concerned with are dramatically increased risk of thyroid cancer and muscle loss at a 2/3 increased rate than any other type of weight loss. The thyroid is the master gland and compromising it seems foolish and I suppose the crazy “Ozempic face “ and saggy skin side effect is a physical manifestation of the dramatic muscle loss.

Diabetes and being over weight are lifestyle diseases. Eat Whole Foods, cut out all processed foods and seed oils and eat more fat and animals, hormonal health will return and weight loss will happen versus the side effects of big pharmaceutical products that only lead to more pharmaceutical products.

[Anonymous]

20% reduction in heart disease, heart attacks, and stroke. Data out yesterday. Amazing.

[Anonymous]

Anonymous wrote:There’s a woman I know on wegovy, lost about 90 lbs and looks disastrous. Saggy facial skin that has fallen to her droopy neck. Droopy as in her neck sags 3” off her jawline with folds and crinkles! Thin skin on arms hangs 5”. Wrinkled skin at thighs hangs below her knees. Her butt looks like she wears a diaper because there’s so much excess skin. She has no muscle tone and I swear her skin moves when the wind blows. And she’s losing her hair. She aged at least 10 years in a fraction of one. And I think she knows it because she’s been piling on the make up. And that’s only what I can see, who knows what her mid section looks like. Maybe I’m too vain but who wants to look worse after weight loss? Op, think long and hard.

You are a vile person.

[Anonymous]

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!!

OP, I am sorry that you are being treated so poorly by people on this board. People seem to take so much pleasure in abusing people struggling with weight. I hope you can work with your doctor and insurance company to get it approved. Good luck!

[Anonymous]

Anonymous wrote:Can the person spouting lies about there not being a shortage please shut their pie hole? The drug shortage website clearly lists the shortage, so stop being selfish and trying to justify why you need this drug for vanity reasons.

The person saying there’s no shortage is referring to Ozempic. There is no Ozempic shortage. It’s the correct substitute for Wegovy so there should be nothing wrong with taking it instead. Insurance games though.

[Anonymous]

Anonymous wrote:20% reduction in heart disease, heart attacks, and stroke. Data out yesterday. Amazing.

Which is why I’m on it even though so many people on this board would say I should just eat less. I don’t look obese but you can’t see my health history.