Anonymous wrote:This is OP. We can try to appeal but am not hopeful. It was hard and took a long time to get them to cover in the first place. They denied it for a long time and finally covered after lots of appeals. Now they are dropping coverage.

It sounds like paying out of pocket through Lily might be the only option if we don’t want to do a compounded version. If I understand correctly, those are still around 200 each month or more?

It depends on your dose. I am currently paying about $170/mo for compound tirzepatide but for 5mg/week.

This is OP. We can try to appeal but am not hopeful. It was hard and took a long time to get them to cover in the first place. They denied it for a long time and finally covered after lots of appeals. Now they are dropping coverage.

It sounds like paying out of pocket through Lily might be the only option if we don’t want to do a compounded version. If I understand correctly, those are still around 200 each month or more?

Anonymous wrote:Can't you appeal? The doctor prescribing it should be able to show that it is medically necessary.

Doubtful this will work. Insurance regs to get Wegovy/Zepbound (the weight loss Rx’s) haven’t caught up to the FDA yet. ozempic / mounjarno is accessible with T2 diagnosis. I haven’t run into a ton of plans that don’t cover the O/M rx’s (I consult on health care plans)

I pay to get my Zepbound directly through Lilly. No way am I messing with an Rx this power from a non direct source. You could look into the pill rather than the injection; it is less expensive.

It’s nearly impossible to make it medically necessary in terms of insurance, but ask anyway.
I have to buy direct from novo nordisk. I could go to Costco, but my dr had used NN and was used up sending scrips there. They offer assistance to some people with certain insurances, but not mine. I pay $349 a month and I’ve had to sacrifice other creature comforts to afford it. I have to wean off slowly, I tried going off and had terrible gastric side effects. Not going through that again.
I have started injecting every 10 days, then will stretch to 14, etc. so it’s cheaper overall.

Can't you appeal? The doctor prescribing it should be able to show that it is medically necessary.

We just got letters that our GLPs will no longer be covered as of 7/1. DH and I are both on it for weight loss but have several other heath conditions (high blood pressure, high cholesterol, he has sleep apnea). For those of you who have been through similar, what did you do? We know we can self pay through Lily Direct. Is this the best option? It’s expensive.

We are curious to hear if you have a positive experience with compounding pharmacies and how much you pay.