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

[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.

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.

[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 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.

NP I agree with you and they should pay for Wegovy. Even though Ozempic is the same, it’s a different name for a different diagnosis. Semantics to us but not them.

My insurance approved Wegovy but I can’t get my dose right now so I’m paying out of pocket for Ozempic. Next month I should be able to get Wegovy and insurance will cover it.

[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 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.

[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 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?

[Anonymous]

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.

[Anonymous]

huh? i am not asking how to break rules. i am asking what other rules are out there that i can use to my advantage.

like, for example, filing an appeal. or having doctor write a letter to confirm that i have in fact, tried many times to lose weight.

[Anonymous]

Anonymous wrote:I am 50 pounds overweight and marginally pre-diabetic. DR put in a prescription for Ozempic but express scripts denied it. what can I do now?

Do you have diabetes? If not, you’re SOL and don’t qualify. Try Wegovy. I take ozempic, but I have diabetes and I’m delighted insurance companies have started clamping down.

[Anonymous]

Anonymous wrote:Go to a real doctor?

Op’s real doctor has likely denied it because it’s not for weight loss, so she’s doing it online.

[Anonymous]

Your doctor is an idiot. He should have put in a request for Wegovy, which is what you need to lose weight.

[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.

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

[Anonymous]

Anonymous wrote:

Anonymous wrote:Ozempic has been a miracle for me, but in terms of insurance coverage you just have to call your insurance company aand see if there’s anything you can do but Ozempic probably won’t be covered for you.

it's covered but has this preauthorization process which I don't understand. it looks like some condition needs to be met for the coverage, but nobody stated what the condition is.

The pre authorization is because this medication is for type 2 diabetes, not prediabetes or weight loss or pcos or anything else that op can come up with.

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

[Anonymous]

So, given how pervasive obesity is, what happens with insurance premiums if the volume of filled prescriptions goes way up subsidized by insurance companies?

[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 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.

Op could treat her ‘pre diabetes’ with metformin like everyone else or pay for Wegovy, but she’s special and wants the insurance company to make a special exception for her special ozempic prescription. Hun, you’re gonna have to get compounded or pay $1000 a month like everyone else.

[Anonymous]

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.

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

You’re sooooo defensive. And you’re not the board monitor, so take a seat. DP