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

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

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[quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous]Insurance companies decide what is covered. Not your doctor, OP. You can get a prescription, no one is stopping you. But you won’t have it covered so stop  complaining, or else eat more bad food so you get full blown diabetes and then it will be covered.[/quote]

insurance company does cover both ozempic and wegovy. so they already decided they would do it.

and my doctors think i need them. it's weird to me that there the company needs to make additional approval to cover the medicine they already decided to cover. if they don't want to cover wegovy, fine. but why second guess my doctor? why would they know better what i need?[/quote]

Because they know people would drop them if they took Wegovy off the formulary. [/quote]

Most people have insurance through their employer so this idea that individuals impulsively drop carriers is a fiction. There’s only one open enrollment season anyway.[/quote]

I pay for Ozempic out of pocket and but insurance through the exchange (self employed) and I’m definitely going to try to switch to a plan that will cover it. I doubt I can find one, unfortunately. I was the high end of prediabetic and I was solidly obese when I started but I’ve lost 45 lbs so far thanks to Ozempic so idk how I could qualify now, perversely.

US healthcare is dumb. The only silver lining is that this problem will sort itself out in the next decade or so. There will be so much competition and eventually easier to navigate generics. We’re all just stuck in this penalty period where the pharma companies suck up the profit. Although…they kind of deserve it? They may have cured obesity. If these drugs work for even a slice of people as well as they have worked for me, our collective healthcare costs will go down a lot. I feel like my whole life I thought I was just weak/crazy and now I feel like I’m in control of my life again. [/quote]

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