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

[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.

This is the same type of thinking that mental health has struggled to overcome. If you only focused, you would do better in school. If you didn’t stim and weren’t rigid, you would have friends. If you could control your emotions, your life would be calmer.

Not everyone is wired the same. Some people have weight issues, others have ADHD/Austin/Mood Disorders. Medication is there to help people that need 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.

Holy overreaction, Batman. OP said diets have only made her gain more, which is common and something we've known for a long time - that diets don't work. Restricting doesn't work. Lowering cabs doesn't work.

[Anonymous]

Anonymous wrote:

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.

+1

[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.

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.

Why can't you eat a little bit of everything long term?

Respectfully, walking and 10k steps don't do much - it's quality, not quantity. 5k steps on stairs or hills, or adding in weights (that are challenging) will do more than simple walking.

[Anonymous]

Have you tried Metformin and berberine, OP?

[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.

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.

It's not about punishing you. It's increasing irritation with people like you who try to game the system, up to and including committing outright insurance fraud. We know, we know, you're special, and you *deserve* for your insurance to pay thousands of dollars to cover this drug even though you don't meet the established criteria. But you're really not different than thousands of other people, despite what you think, or have been told.

[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?

Watch what you eat and exercise!!!!!

[Anonymous]

Anonymous wrote:

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.

Even if this is true, and it's just speculation, it doesn't change the fact that weight loss now *may* mean, *in the future,* that premiums might not be as high. But putting thousands of people on a drug that costs what Ozempic does will indisputably increase premium costs *now.* People who need it for medical conditions? Of course they should get it - expensive drugs are covered all the time. It's people who *don't* meet the criteria, like OP, yet still feel like they deserve it, who get others riled up. That's completely legit.

[Anonymous]

Anonymous wrote:

Anonymous wrote:thank you! I will look at the appeal process.

There is a protocol. You will need to try Metformin first for the diabetes. Ozempic is not indicated for weight loss so that’s not going to get the approval.

What, exactly, is “marginal pre-diabetes?”

I was 40 pounds overweight but my A1c was fine until it wasn’t. Doctor put me on metformin, I got off my fat a$$ and moved around, cut the carbs and between all of that within a year my A1c went from 8.2 to 5.4.

This is why you’re being denied Ozempic. There are other options.

[Anonymous]

Anonymous wrote:

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.

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.

It's not about punishing you. It's increasing irritation with people like you who try to game the system, up to and including committing outright insurance fraud. We know, we know, you're special, and you *deserve* for your insurance to pay thousands of dollars to cover this drug even though you don't meet the established criteria. But you're really not different than thousands of other people, despite what you think, or have been told.

are you the IUI person? i am sorry, perhaps you should have started TTC when you were 25?

[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?

Yeah, that’s a lie.

[Anonymous]

Anonymous wrote:

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.

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.

It's not about punishing you. It's increasing irritation with people like you who try to game the system, up to and including committing outright insurance fraud. We know, we know, you're special, and you *deserve* for your insurance to pay thousands of dollars to cover this drug even though you don't meet the established criteria. But you're really not different than thousands of other people, despite what you think, or have been told.

what are you talking about? i meet all the cigna criteria for wegovy. you misread the insurance criteria, then accused me of insurance fraud because... you want me to lose the weight the hard instead of an easy way.

rather than lecturing me on food and exercise and insurance policies, you need to reflect on why you are so invested in having fat people punished.

[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.

So OP can get Wegovy. Same medication. Problem solved and you can go back to your cave.

[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.

You are not the right kind of candidate for Ozempic. Shame on you.

[Anonymous]

Anonymous wrote:

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.

You are not the right kind of candidate for Ozempic. Shame on you.

you are insane.