OP here – thanks for this. I was hoping I could use my starting BMI on my PA renewal, but my doctor said it’s based on current BMI. I have CVS Caremark for pharm benefits, and I haven’t been able to find clear info on whether they historically renew GLP-1s for people whose BMI has dropped below 30. The CVS associates I’ve spoken with made it seem like renewals can go through with clinical notes, doctor justifications, and health metrics... not sure though.

Also, thanks for the recs, I’ll check them out. I’m in MD but willing to drive for this

(As an aside, I’m aware of the CVS formulary change re: Zep. When I called, they told me my PA will automatically switch to Wegovy on July 1. If I experience side effects, I can ask for an exception. I’m hoping Wegovy works well enough since I’m near goal weight, but I guess we’ll see.)

thanks again

Anonymous wrote:

Anonymous wrote:Talk to Colleen Jurgens (she’s a NP) with INOVA Obesity Clinic.

https://www.inova.org/doctors/colleen-l-jurgens-fnp

Also, it’s my understanding that insurance looks at your starting BMI to determine eligibility so the fact that you lost the weight and now have a healthy BMI would not affect insurance coverage.

It depends on the plan.

You might get more info if you post your insurance. It really depends more on whether your insurance will cover - if it doesn’t then no doctor, no matter how supportive, can get it covered.

Anonymous wrote:Talk to Colleen Jurgens (she’s a NP) with INOVA Obesity Clinic.

https://www.inova.org/doctors/colleen-l-jurgens-fnp

Also, it’s my understanding that insurance looks at your starting BMI to determine eligibility so the fact that you lost the weight and now have a healthy BMI would not affect insurance coverage.

Talk to Colleen Jurgens (she’s a NP) with INOVA Obesity Clinic.

https://www.inova.org/doctors/colleen-l-jurgens-fnp

I see Dr. Ali at VHC and their nutritionist and psychologist. I am not at goal weight yet so I can’t answer that part. He definitely considers it a lifelong medication though. My plan explicitly excludes weight loss drugs so I
Pay $500/month through Eli Lilly

Your irritation is misplaced. Your doctor is correct that your insurance won’t cover it. That is not within their control. You no longer qualify.
I’ve heard the same story from friends. Most were happy enough they just paid out of pocket to stay on maintenance.

If anyone has recommendations for doctors who are supportive of long-term GLP-1 use for maintenance after reaching a healthy BMI and all the tricky insurance things that come along with that… please send them my way. I’d be so grateful!

Longer story-
I’ve been on Zepbound since November and it has truly changed my life. I’ve lost over 30 lbs on it (and about 20 lbs on my own before that, but that part has been going up and down for years). I’m a shorter woman with PCOS, and I’ve been overweight or obese since I was a teen (now early 40s). Weight Watchers on and off since age 15, binge eating, sugar problems, bad cholesterol, etc. But I'm also athletic and really do my best, always, to be healthy within what I could do - only really succeeding when I let healthy eating consumer my life. Basically, I’ve worked really hard just to be “a little obese” most of my adult life, but Zepbound has finally made things feel manageable and sustainable. Honestly, for the first time ever my brain is good.

I’m now approaching goal-weight territory and starting to think about maintenance over the next 6ish months. I would love to get to a comfortably healthy BMI range (maybe even a bit low in the healthy range for some wiggle room) and then stay there. Right now I am just under 27 BMI. I’d be totally comfortable staying on a low-dose maintenance plan long-term, because the past 6 months have been amazing, not just physically, but mentally and emotionally too. I've been on 5mg the whole time.

Here’s the problem... My current doctor says that because I’m nearing a healthy BMI, I no longer “need” the medication and probably won’t get approved for a new PA. (I definitely won't if that is her attitude!). She’s recommending tapering off now and says I can always go back on if I regain 10–15 lbs because then my BMI will be higher. But that makes no sense to me, why stop something that’s working so well just to cycle back later? I'm not feeling supported.

I’ve read about doctors who view obesity as a chronic condition and understand the importance of long-term support and maintenance dosing even when reaching a good BMI. I see it here on DCUM and on Reddit. I would really love to find someone like that. Ideally in the DM area or via telehealth. Thank you!!