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

[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.

Stop doing diets. Eat a little less (of everything), and move more. Move every single day.

[Anonymous]

Anonymous wrote:

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

I had gestational diabetes with my last pregnancy which makes one a likely candidate to develop diabetes as they get older. For the next 10 years, I worked like a dog to stay fit—did Weight watchers, lifted weights, ran a marathon. And then I turned 50. I tried and tried to lose weight—again, did Weight Watchers religiously and worked out. My 54-year old body was not dropping any of the the 30lbs I needed to lose. And my A1C was 5.8 (pre-diabetic)

I was prescribed Ozempic and have been taking it for a year. I pay $25/month. Lost 25lbs and A1C is now in normal range. I feel great and have no issue with taking this drug forever.

OP-I hope you can get this covered. It’s a great drug. I’ve have minimal side effects. Fatigue is the worst part. The best part is that the “food noise” is gone.

[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.

Stop doing diets. Eat a little less (of everything), and move more. Move every single day.

I’m so sick of posts like this. The implication is that is just really easy, and if you struggle and don’t actually lose weight, it’s a moral failing on your part. If you’ve ready anything about this drug, you’d know that it’s being looked at as a way to treat addiction. Open up your mind to the possibility that some people are just wired differently. They process food and experience hunger differently than you.

[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.

Stop doing diets. Eat a little less (of everything), and move more. Move every single day.

it's amazing that you are confident you know what my habits are.

i make more than 10k steps every day. i can't eat little bit of everything, not long term. i my on intermittent fasting right now, which has worked best for my, historically, and i am waking multiple times every night with hunger pangs.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

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

I had gestational diabetes with my last pregnancy which makes one a likely candidate to develop diabetes as they get older. For the next 10 years, I worked like a dog to stay fit—did Weight watchers, lifted weights, ran a marathon. And then I turned 50. I tried and tried to lose weight—again, did Weight Watchers religiously and worked out. My 54-year old body was not dropping any of the the 30lbs I needed to lose. And my A1C was 5.8 (pre-diabetic)

I was prescribed Ozempic and have been taking it for a year. I pay $25/month. Lost 25lbs and A1C is now in normal range. I feel great and have no issue with taking this drug forever.

OP-I hope you can get this covered. It’s a great drug. I’ve have minimal side effects. Fatigue is the worst part. The best part is that the “food noise” is gone.

What is food noise?

[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.

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.

How am I not well? I am telling OP the facts of the matter. This is what most insurance protocols will require.

OP looks to be taking a short cut. She’s asking for Ozempic, which is indicated for diabetes. If that’s how it’s coded they will likely say try Metformin first. This is just as it is.

If she’s just trying to get an easy fix to being a fatty, she’s asking for the wrong medicine name. But even then they want to see some effort at weight loss before they will prescribe this thing as it’s not a silver bullet.

[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.

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.

Yeah, it couldn't possibly be operator error, could it?

[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.

Stop doing diets. Eat a little less (of everything), and move more. Move every single day.

I’m so sick of posts like this. The implication is that is just really easy, and if you struggle and don’t actually lose weight, it’s a moral failing on your part. If you’ve ready anything about this drug, you’d know that it’s being looked at as a way to treat addiction. Open up your mind to the possibility that some people are just wired differently. They process food and experience hunger differently than you.

It *is* easy. Write down everything you eat, keep your calories under about 1,800 and your carbs under 125 a day. Increase your fiber and water consumption. Walk at least four miles four times a week. The weight will come off. Fast.

[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.

DP here - In your initial post, you said you were "marginally pre-diabetic" and have repeated that several times. But now you don't know what prediabetes is?

Look, OP, it's clear you want Ozempic to lose weight, and are looking for a way to make that happen. Just own it.

[Anonymous]

Anonymous wrote:

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.

actually, this shows the opposite - that my GP is not very familiar with weight loss medicines, which "fake doctors" prescribing weight loss medicines probably are.

[Anonymous]

Anonymous wrote:

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.

DP here - In your initial post, you said you were "marginally pre-diabetic" and have repeated that several times. But now you don't know what prediabetes is?

Look, OP, it's clear you want Ozempic to lose weight, and are looking for a way to make that happen. Just own it.

i am owning it from the very first post. i am telling you what my doctor, who gave me a prescription for ozempic, told me, and what her justification was. if i can milk that diagnosis to get ozempic, i will do so. yes, i want to take advantage of these new medicine to lose weight, like a gazillion of other people.

i am also prescribed wegovy by a different doctor in the same practice. i am still waiting for approval there.

[Anonymous]

oh, and if my insurance doesn't cover it, i will pay for it out of pocket. and for some reason, this will be more palatable to you - because i will be punishing me, even though you don't know me and it has nothing to do with you.

[Anonymous]

If you bothered to read the requirements for Cigna that someone else posted, you will see you will be required to lose at least 5% of your body weight prior to being given Wegovy.

Maybe this is why OP is gunning so hard for Ozempic on the “marginal pre-diabetes” argument (which won’t fly)..

Bottom line is you won’t just be issued these drugs. One way or another there are intermittent steps — metformin for a diabetes diagnosis and if that doesn’t improve A1C, you get Ozempic, but that is at least three months away.

For Wegovy, you have to lose at least 5% of your body weight before they will approve it. This is to demonstrate a commitment to what it will take to sustain any weight loss since you will only be approved for the it for between 5 months and one year,

So if you are 200 pounds, get that documented and work to lose at least 10. That will also take you about two-three months. Then you might get the meds.

[Anonymous]

Anonymous wrote:oh, and if my insurance doesn't cover it, i will pay for it out of pocket. and for some reason, this will be more palatable to you - because i will be punishing me, even though you don't know me and it has nothing to do with you.

No one is “punishing” you for being fat — drop that victimhood mentality.

People are reacting to your attitude and sense of entitlement and determination to find short cuts.

And yes, this has to do with us. It’s people with the mentality you are displaying that are causing shortages of this medication for those of us who legitimately qualify to receive it. And didn’t take short cuts.

[Anonymous]

Anonymous wrote:

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.

Stop doing diets. Eat a little less (of everything), and move more. Move every single day.

I’m so sick of posts like this. The implication is that is just really easy, and if you struggle and don’t actually lose weight, it’s a moral failing on your part. If you’ve ready anything about this drug, you’d know that it’s being looked at as a way to treat addiction. Open up your mind to the possibility that some people are just wired differently. They process food and experience hunger differently than you.

It *is* easy. Write down everything you eat, keep your calories under about 1,800 and your carbs under 125 a day. Increase your fiber and water consumption. Walk at least four miles four times a week. The weight will come off. Fast.

If it were that easy this board wouldn’t exist. It’s easy for you but not for many others. Just like it’s super easy for me not to be addicted to nicotine because I’ve never smoked or wanted to smoke, but I don’t tell people who’ve smoked six packs for years that it’s so easy to stop. It’s hard. You may be the gloriously lucky person for whom all these things are easy, but the rest of us aren’t as perfect as you.