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

[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.

That is not a “fact” in any way whatsoever. Sorry, the laws of science apply to you too.

[Anonymous]

Op the reason the insurance wants a pre authorization is because they want to know why you want the medication. You won’t be approved with marginal diabetes, full stop. Your insurance company will put you on metformin and there is no step therapy for pre diabetics, you don’t qualify.

[Anonymous]

Anonymous wrote:

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.

i am truly interested to know what prompts you to post garbage like this?

no, my real doctor prescribed ozempic. this was my GP. then, later, i went to the weight loss specialist in the same practice and he prescribed wegovy. wegovy has not been rejected, yet.

[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.

That is not a “fact” in any way whatsoever. Sorry, the laws of science apply to you too.

as i said, i've been dieting for 40 years and i am now 50 pound overweight. unaided dieting does not work for me. it's a fact.

[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.

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.

[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 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!!

[Anonymous]

Anonymous wrote:

Anonymous wrote:

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.

i am truly interested to know what prompts you to post garbage like this?

no, my real doctor prescribed ozempic. this was my GP. then, later, i went to the weight loss specialist in the same practice and he prescribed wegovy. wegovy has not been rejected, yet.

Well I posted because your doctor is an idiot, because ozempic is not for prediabetes, so you won’t be approved. If your doctor was legit, he would have prescribed metformin because that’s the first step for prediabetes.

[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!!

Mine is $15/month because I have diabetes. You don’t.

[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.

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

[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.

People are now looking into how each plan covers GLP1 inhibitors before signing on. Consumers are getting smarter these days. Sorry.

[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.

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.

So you don’t know anything about it and don’t want to take it even though it helps cure “marginal prediabetes” but you WILL take the Ozempic? That makes not much sense. It’s like saying I won’t take Tylenol for this headache, I’d prefer the OxyContin.

In any case, you won’t get approved for Ozempic with “marginal prediabetes.” You need to have diabetes. If you just want a weight loss drug because you don’t actually care about the fact you’re prediabetix so won’t take metformin, see if they’ll approve Wegovy. Understand one of the major compounders in the US is having “shortages” right now or something or is closed and Wegovy is hard to get at the moment.

[Anonymous]

What is your BMI? It's not hard to get wegovy immediately but ozempic may have more stringent diabetes requirements. Call you insurance for the requirements.

[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!!

Wegovy is covered if your BMI exceeds 35

[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 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!!

Wegovy is covered if your BMI exceeds 35

you must have a BMI of 30 or higher or a BMI of 27 or higher with at least one weight-related medical condition.

[Anonymous]

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

DP but I don’t think you should worry about this honestly, mainly because:
A) the drug (and others like it) isn’t inherently expensive. Eventually there will be low cost generics and more competitors that will bring prices down. Pharma will try to slow it, but think of how cheap Prozac is now.

B) to the extent that people are successful at reversing obesity with this medication, the overall savings to the system could be staggering. Obesity comes with a lot of expensive consequences which ARE covered by insurance.