Anonymous wrote:

Anonymous wrote:Your primary care can prescribe it for you if you explain that it is the one that is covered, etc. But, that doesn't mean that your insurance will cover it - many require prior authorization and proof of a diagnosis. You can appeal and may get lucky but it depends on the insurer.

Op here. How can you tell if a P.A. would be required?

You need to check your insurance coverage. Mine is very specific about step therapy, quantity limits and authorization.

Plans may also specify the conditions for which it’s covered. Some plans are very restrictive, meaning T2 diabetes only, and other plans are more inclusive.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Anyone know any telehealth places prescribing Mounjaro without a diabetes diagnosis? I have coverage for that but not Zepbound. I've been on it before and then moved to compounded Tirzepetide which got too expensive. So now I'm not on anything and hate the way I feel. Gaining again, despite normal food consumption and SO much inflammation.

OR does anyone know of a telehealth place to get compounded Tirzepetide that isn't crazy expensive??

This isn't going to happen since it's indicated for diabetes. Even if you found some unethical doctor to prescribe it for you, your insurance company isn't going to cover it if you don't have diabetes.

OP here. It's not unethical to prescribe medication for other purposes. Also Zepbound and Mounjaro are exactly the same.

It's unethical when the run on semaglutides by fatties causes a shortage for diabetics. The reason your insurance covers Mounjaro is it is intended to treat diabetes. It doesn't want to cover Zepbound because it thinks you should eat less and move more -- it's not going to cover an expensive medication for you to take a shortcut. Trying to do an end-run around this division would be unethical by a practitioner.

Most people on semaglutides have tried to eat less and move more for a long time before they ended up at a doctor's office seeking an expensive drug that they have to inject into themselves. Mounjaro is newer. Supply will catch up with demand, as it has for semaglutides. It's a fantastic drug that can be mass-produced and ultimately save our healthcare system a lot because it can prevent full-on diabetes, mitigate alcoholism, and have a profound effect on other metabolic conditions if it is administered correctly.

Right? I’ve spent my entire adulthood fighting my weight… I’m not overweight because I’m lazy or eat a ton … semaglutide was ok but not great for me. Tirzepetide allowed me to lose 70 lbs and not the weight is creeping back up despite changing no habits. It’s so frustrating. I wish I didn’t need it.

Anonymous wrote:Your primary care can prescribe it for you if you explain that it is the one that is covered, etc. But, that doesn't mean that your insurance will cover it - many require prior authorization and proof of a diagnosis. You can appeal and may get lucky but it depends on the insurer.

Op here. How can you tell if a P.A. would be required?

Your primary care can prescribe it for you if you explain that it is the one that is covered, etc. But, that doesn't mean that your insurance will cover it - many require prior authorization and proof of a diagnosis. You can appeal and may get lucky but it depends on the insurer.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Anyone know any telehealth places prescribing Mounjaro without a diabetes diagnosis? I have coverage for that but not Zepbound. I've been on it before and then moved to compounded Tirzepetide which got too expensive. So now I'm not on anything and hate the way I feel. Gaining again, despite normal food consumption and SO much inflammation.

OR does anyone know of a telehealth place to get compounded Tirzepetide that isn't crazy expensive??

This isn't going to happen since it's indicated for diabetes. Even if you found some unethical doctor to prescribe it for you, your insurance company isn't going to cover it if you don't have diabetes.

OP here. It's not unethical to prescribe medication for other purposes. Also Zepbound and Mounjaro are exactly the same.

It's unethical when the run on semaglutides by fatties causes a shortage for diabetics. The reason your insurance covers Mounjaro is it is intended to treat diabetes. It doesn't want to cover Zepbound because it thinks you should eat less and move more -- it's not going to cover an expensive medication for you to take a shortcut. Trying to do an end-run around this division would be unethical by a practitioner.

The problem is the pen injector, not the availability of the actual medication. Which is part of the reason that Eli Lilly will be selling Zepbound in vials for patients to inject with a syringe at certain strengths.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Anyone know any telehealth places prescribing Mounjaro without a diabetes diagnosis? I have coverage for that but not Zepbound. I've been on it before and then moved to compounded Tirzepetide which got too expensive. So now I'm not on anything and hate the way I feel. Gaining again, despite normal food consumption and SO much inflammation.

OR does anyone know of a telehealth place to get compounded Tirzepetide that isn't crazy expensive??

This isn't going to happen since it's indicated for diabetes. Even if you found some unethical doctor to prescribe it for you, your insurance company isn't going to cover it if you don't have diabetes.

OP here. It's not unethical to prescribe medication for other purposes. Also Zepbound and Mounjaro are exactly the same.

It's unethical when the run on semaglutides by fatties causes a shortage for diabetics. The reason your insurance covers Mounjaro is it is intended to treat diabetes. It doesn't want to cover Zepbound because it thinks you should eat less and move more -- it's not going to cover an expensive medication for you to take a shortcut. Trying to do an end-run around this division would be unethical by a practitioner.

Most people on semaglutides have tried to eat less and move more for a long time before they ended up at a doctor's office seeking an expensive drug that they have to inject into themselves. Mounjaro is newer. Supply will catch up with demand, as it has for semaglutides. It's a fantastic drug that can be mass-produced and ultimately save our healthcare system a lot because it can prevent full-on diabetes, mitigate alcoholism, and have a profound effect on other metabolic conditions if it is administered correctly.

Hi OP, I’m on Mounjaro for metabolic syndrome. I do not have diabetes. I have Carefirst with Caremark as my PBM.

My provider (PA I see in person here in NOVA) prescribed Mounjaro (MJ) back in September 2022 and I was able to start it due to the original $25 savings card. I was finally able to get coverage for it after my provider submitted a prior authorization (denied) and I submitted an appeal to the denial. I was covered for a full year (2023-2024) and had to do the prior auth/appeal again for year 2 (2024-2025).

My appeals were based on my diagnosis of metabolic syndrome. Plus I had to complete step therapy and try metformin, Victoza, Trulicity and Ozempic. I also had to enroll in a free Noom program aimed at diabetes prevention.

It’s not impossible but definitely more of a challenge to get covered for Mounjaro as a non-diabetic.

Alternatively you can find compounded tirzepatide via Join Mochi or Fridays (both telemedicine) for about $300 a month.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Anyone know any telehealth places prescribing Mounjaro without a diabetes diagnosis? I have coverage for that but not Zepbound. I've been on it before and then moved to compounded Tirzepetide which got too expensive. So now I'm not on anything and hate the way I feel. Gaining again, despite normal food consumption and SO much inflammation.

OR does anyone know of a telehealth place to get compounded Tirzepetide that isn't crazy expensive??

This isn't going to happen since it's indicated for diabetes. Even if you found some unethical doctor to prescribe it for you, your insurance company isn't going to cover it if you don't have diabetes.

OP here. It's not unethical to prescribe medication for other purposes. Also Zepbound and Mounjaro are exactly the same.

It's unethical when the run on semaglutides by fatties causes a shortage for diabetics. The reason your insurance covers Mounjaro is it is intended to treat diabetes. It doesn't want to cover Zepbound because it thinks you should eat less and move more -- it's not going to cover an expensive medication for you to take a shortcut. Trying to do an end-run around this division would be unethical by a practitioner.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Anyone know any telehealth places prescribing Mounjaro without a diabetes diagnosis? I have coverage for that but not Zepbound. I've been on it before and then moved to compounded Tirzepetide which got too expensive. So now I'm not on anything and hate the way I feel. Gaining again, despite normal food consumption and SO much inflammation.

OR does anyone know of a telehealth place to get compounded Tirzepetide that isn't crazy expensive??

This isn't going to happen since it's indicated for diabetes. Even if you found some unethical doctor to prescribe it for you, your insurance company isn't going to cover it if you don't have diabetes.

OP here. It's not unethical to prescribe medication for other purposes. Also Zepbound and Mounjaro are exactly the same.

People with diabetes actually need this drug. My sister has diabetes and needs it but has to ration it thanks to people like OP.

There is plenty of semaglutide out there it works for 99% of people. For the rest, Mounjaro. OP sounds like a semaglutide alone didn't work for her so she's the 1% that needs Mounjaro.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Anyone know any telehealth places prescribing Mounjaro without a diabetes diagnosis? I have coverage for that but not Zepbound. I've been on it before and then moved to compounded Tirzepetide which got too expensive. So now I'm not on anything and hate the way I feel. Gaining again, despite normal food consumption and SO much inflammation.

OR does anyone know of a telehealth place to get compounded Tirzepetide that isn't crazy expensive??

This isn't going to happen since it's indicated for diabetes. Even if you found some unethical doctor to prescribe it for you, your insurance company isn't going to cover it if you don't have diabetes.

OP here. It's not unethical to prescribe medication for other purposes. Also Zepbound and Mounjaro are exactly the same.

The haters are going to hate. I am pre-diabetic (I had gestational diabetes during pregnancy), so I don't qualify through insurance, but I got on it anyway for full pay, and it blew me away. I followed the recommended high protein diet plus 4-5x weekly weight training to hopefully sustain the weight loss when I go off it. I tried to "will" my way to lose this weight for 10 years with no success. I am hoping it has cured my sugar addiction. At my doctor's advice, I also gave up alcohol when I started, and I haven't had any craving for alcohol. If you pay this much, you're crazy not to go all in with the necessary lifestyle changes.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Anyone know any telehealth places prescribing Mounjaro without a diabetes diagnosis? I have coverage for that but not Zepbound. I've been on it before and then moved to compounded Tirzepetide which got too expensive. So now I'm not on anything and hate the way I feel. Gaining again, despite normal food consumption and SO much inflammation.

OR does anyone know of a telehealth place to get compounded Tirzepetide that isn't crazy expensive??

This isn't going to happen since it's indicated for diabetes. Even if you found some unethical doctor to prescribe it for you, your insurance company isn't going to cover it if you don't have diabetes.

OP here. It's not unethical to prescribe medication for other purposes. Also Zepbound and Mounjaro are exactly the same.

People with diabetes actually need this drug. My sister has diabetes and needs it but has to ration it thanks to people like OP.

I haven't used this person, but just listened to her on a podcast and loved what I heard she indicated on the podcast that takes telehealth patients and will prescribe Mounjaro:

Lauren Fitz: https://larimarmed.com/meet-the-team/

https://www.instagram.com/drlaurenfitz/?hl=en

Anonymous wrote:

Anonymous wrote:Anyone know any telehealth places prescribing Mounjaro without a diabetes diagnosis? I have coverage for that but not Zepbound. I've been on it before and then moved to compounded Tirzepetide which got too expensive. So now I'm not on anything and hate the way I feel. Gaining again, despite normal food consumption and SO much inflammation.

OR does anyone know of a telehealth place to get compounded Tirzepetide that isn't crazy expensive??

This isn't going to happen since it's indicated for diabetes. Even if you found some unethical doctor to prescribe it for you, your insurance company isn't going to cover it if you don't have diabetes.

OP here. It's not unethical to prescribe medication for other purposes. Also Zepbound and Mounjaro are exactly the same.

Anonymous wrote:Anyone know any telehealth places prescribing Mounjaro without a diabetes diagnosis? I have coverage for that but not Zepbound. I've been on it before and then moved to compounded Tirzepetide which got too expensive. So now I'm not on anything and hate the way I feel. Gaining again, despite normal food consumption and SO much inflammation.

OR does anyone know of a telehealth place to get compounded Tirzepetide that isn't crazy expensive??

This isn't going to happen since it's indicated for diabetes. Even if you found some unethical doctor to prescribe it for you, your insurance company isn't going to cover it if you don't have diabetes.

Anyone know any telehealth places prescribing Mounjaro without a diabetes diagnosis? I have coverage for that but not Zepbound. I've been on it before and then moved to compounded Tirzepetide which got too expensive. So now I'm not on anything and hate the way I feel. Gaining again, despite normal food consumption and SO much inflammation.

OR does anyone know of a telehealth place to get compounded Tirzepetide that isn't crazy expensive??