Doc wants me on Ozempic?!

HawkLog174

HawkLog174

Member
So, my physician wants me to begin taking Ozempic. I don't believe he's aware that my state Medicaid probably won't cover it. I'm in Indiana, and it seems it's not typically covered for just weight reduction. I'm about 375 pounds in weight, and he's worried. He wants me to slim down, and thinks this could be the most viable solution. So I'm kinda stuck. Working out hasn't helped. I can't control my hunger. I hate this feeling.
 
I didn't expect Medicaid to cover it, but my doctor sent in the script anyway and said to see what happens. Next time I went to pick up a different script, they had Ozempic ready for me. I was shocked. Tell your doctor to go ahead and send it in and see if it gets approved. I'm in Iowa btw
 
Your doctor may need to complete some authorization paperwork. They might want you to use Wegovy instead (which is basically the same, but approved for weight loss). Same with Mounjaro/Zepbound.

Do you have type 2 diabetes? Being obese makes you more likely to develop it. If you do, it might be easier to get coverage. I joke that I manifested T2DM so I can get Ozempic when I'm on Medicare. Seems like Medicaid will pay for bariatric surgery, which makes me think they'd cover a GLP-1 at least in certain cases.
 
How are your kidneys and liver functioning? Any sleep apnea? Previous stroke, cardiac arrest, or severe PAD, or circulatory amputation? Other conditions might enable Wegovy or Zepbound coverage. Your life-threatening illness is being made worse by your morbid obesity. As Medicare and Medicaid offer new prices, expect greater approvals.
 
I'm only about a month in and I'm ready to tell everyone about it.

I don't think I'm just excited because I'm at the start, I'm seeing a big improvement.

I am working out more, getting the protein I never used to, getting rid of big meals, not snacking at night, taking vitamins and drinking lots of water... feeling great so far.

No bad side effects so far.

I may try to get my insurance to pay but decided to pay out of pocket (after seeing others get results).

Worth it.
 
A possibly easier and cheaper way is to use compounded semaglutide instead of name-brand Ozempic. The simplest way to access it is via a weight-loss telehealth company (see link below). No insurance needed. You pay the provider directly, and they work with labs to mail you the medication and other supplies. Never pay a monthly membership fee. Max is about $200 a month, which you should save on eating out, groceries, alcohol, etc.

I'm attaching a link to a different subreddit about compounded tirzepatide (Mounjaro/Zepbound). BUT the telehealth companies listed are legitimate, and they also offer semaglutide (Ozempic/Wegovy) for less. A lot of thought has been put into it, and it's updated often.

Scroll down to no. 5 for an explanation of FDA rules, BUD, 503a vs 503b compounding pharmacies, etc.

Here's the link:
 
If your A1C is at least 6.5, Indiana Medicaid will cover Ozempic. Look at your lab results. You don’t have to be on insulin to be considered diabetic.
 
I agree with the recs above/below me.

If you're dedicated, the decrease in food costs will cover a lot of the cost. My food budget went from around $25 a day (eating out twice a day) to around $300 a month. There are programs for lower costs, and there are also compounding pharmacies.

Ozempic can help with the stress eating. But it's not magic, you have to put in the work. And you might not see results immediately, so on the low doses, don't expect to see the weight fall off quickly. A reasonable goal is about 1lb/week, losing too much too fast can be dangerous.

Tracking apps seem to help a lot of people.

Good luck, it's been great for me.
 
Have you told your doctor that you can't afford the medication? Are there programs they're involved with that could help? My insurance just changed, and they won't cover my medicine. My pharmacist suggested I talk to my doctor, and they have a program where I only pay $5. It's based on income, and I just had to make under $5,000 a month.
 
Hey HawkLog174, maybe check out a cash price at the pharmacy? I saw someone say their insurance price was crazy high, but the cash price was way lower, like $150 a month!
 
Fox_Buddy791 said:
If your A1C is at least 6.5, Indiana Medicaid will cover Ozempic. Look at your lab results. You don’t have to be on insulin to be considered diabetic.
Click to expand...

That's good to know! Definitely check your A1C, HawkLog174. It might make a difference even if you don't feel 'diabetic'.
 
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Thanks everyone for the ideas.

It sounds like there are a few options:

1. Get the script sent in and see what happens
2. Apply for the manufacturers assistance program
3. Look into compounded options to save some money
4. Check my A1C levels

I'll look into these and update.
 
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