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

[Anonymous]

Anonymous wrote:

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.

wegovy is literally a weight loss drug. if someone needs it, it's me.

[Anonymous]

Wegovy, yes. Ozempic, no. Hence why you were denied. Try to push through the Wegovy RX you got.

[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.

please stop.

[Anonymous]

Anonymous wrote:Wegovy, yes. Ozempic, no. Hence why you were denied. Try to push through the Wegovy RX you got.

yes. it seems to be the way to go. thank you.

[Anonymous]

Anonymous wrote: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.

where did you read this?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

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.

wegovy is literally a weight loss drug. if someone needs it, it's me.

But you haven’t met the criteria, which includes losing at least 5% of your body weight without it first. Do that and have it documented and you should get it.

[Anonymous]

Anonymous wrote:

Anonymous wrote: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.

where did you read this?

Read the FDA indications on p. 2 of this link someone else provided on the second page of the thread.

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

You could have read this earlier but instead kept carrying on like you’re some entitled victim here. I read it. So can you. Just like I can lose weight but eating less and moving more and so can you.

I lose 50 pounds on my own before I started Ozempic. Interestingly haven’t lost a pound since.

I had an A1C of 10 though.

[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.

It's not "easy" but it is that simple. For OP to say it's impossible for her to lose weight after 40 years without a medication is BS. She isn't motivated and disciplined enough. I cannot believe that she's never even lost 10 pounds in the past 40 years. It's hard to have a mental overload of what we're accustomed with, but there are plenty of other channels (weight watchers, weight loss centers, MyFitnessPal etc) that don't involve medicine. When insurance covers unnecessary medications, YOU AND I are the one helping pay for it, it's not like CEO Jim is paying for it.

[Anonymous]

i don't get what difference does it make to you whether I pay wegovy out of pocket or through my insurance. you need to reflect on why is this important to you.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote: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.

where did you read this?

Read the FDA indications on p. 2 of this link someone else provided on the second page of the thread.

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

You could have read this earlier but instead kept carrying on like you’re some entitled victim here. I read it. So can you. Just like I can lose weight but eating less and moving more and so can you.

I lose 50 pounds on my own before I started Ozempic. Interestingly haven’t lost a pound since.

I had an A1C of 10 though.

but i already read this. it's a requirement for continuing wegovy, not starting it.

[Anonymous]

Anonymous wrote:i don't get what difference does it make to you whether I pay wegovy out of pocket or through my insurance. you need to reflect on why is this important to you.

When you use insurance, the cost is shared. It's natural for people to be resentful when they don't get coverage for things they really can't control. Hypothetically you can control your weight.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote: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.

where did you read this?

Read the FDA indications on p. 2 of this link someone else provided on the second page of the thread.

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

You could have read this earlier but instead kept carrying on like you’re some entitled victim here. I read it. So can you. Just like I can lose weight but eating less and moving more and so can you.

I lose 50 pounds on my own before I started Ozempic. Interestingly haven’t lost a pound since.

I had an A1C of 10 though.

I’m the one that posted the Cigna requirements. I’ve been on Wegovy for about 20 mo.

The 5% loss that you are reading falls under Continuing Therapy not Initial Therapy. Continuing Therapy is when you go for your 2nd PA. They are looking to validate that Wegovy is working for you. You have to show that you have lost 5% of you weight from your initial starting weight prior to starting Wegovy. At a certain point, you will no longer continue to lose weight. The medication is a lifetime medication so to continue receiving it with insurance converge you show that it worked.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

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.

wegovy is literally a weight loss drug. if someone needs it, it's me.

But you haven’t met the criteria, which includes losing at least 5% of your body weight without it first. Do that and have it documented and you should get it.

You don’t think it’s a little odd that someone should have to prove they can lose weight on their own before being prescribed a weight loss drug? I do. The whole point of the drug is to help with weight loss after all.

[Anonymous]

Anonymous wrote:

Anonymous wrote:i don't get what difference does it make to you whether I pay wegovy out of pocket or through my insurance. you need to reflect on why is this important to you.

When you use insurance, the cost is shared. It's natural for people to be resentful when they don't get coverage for things they really can't control. Hypothetically you can control your weight.

Right. And hypothetically if you eat healthy and exercise you can control having a heart attack, high cholesterol, or high blood pressure. If I don’t have sex, I can control not getting pregnant so why cover BCP.

[Anonymous]

Anonymous wrote:

Anonymous wrote:i don't get what difference does it make to you whether I pay wegovy out of pocket or through my insurance. you need to reflect on why is this important to you.

When you use insurance, the cost is shared. It's natural for people to be resentful when they don't get coverage for things they really can't control. Hypothetically you can control your weight.

And it will cost a lot more in the long run to treat complications from being overweight than to treat the source up front.

This isn’t about the money. It’s about the deep rooted desire, maybe unconscious, to punish people for perceived gluttony. You know, like how a girl wouldn’t need an abortion if she’d kept her legs shut or done a better job of using birth control. Or how she wouldn’t have been raped if she hadn’t worn provocative clothing or gone to that club or not gotten drunk. Same kind of judgment. The issue shouldn’t be judgment, it should be testing the result no matter the origin of the issue.