GLP-1 meds: Insurance coverage?

Compounding pharmacies are a tiny market compared to the big pharmaceutical companies. Big Pharma has a lot of influence. It's unlikely insurance coverage will change anytime soon.
 
My BCBS plan covers my HCG through a specialty pharmacy at Walgreens. I have Carefirst Standard. My urologist said I'm one of a handful of guys in his practice whose insurance covers it. I pay a $65 copay each month. To get it covered, my doctor had to specify it was for secondary hypogonadism. Maybe this info will help someone, I dunno.
 
My doctor mentioned that I could try to get a glucose tolerance test to see if I could get an official diabetes diagnosis, since insurance is more likely to cover Ozempic if you have diabetes. But then it's on your record forever.
 
My doctor asked me if I wanted to try medication, but I think it's too expensive. Then when I checked my insurance, Ozempic and Mounjaro are super cheap, like $35/month, but Wegovy is almost $800! Zepbound isn't covered at all!
 
Just_Jilly_K said:
My doctor asked me if I wanted to try medication, but I think it's too expensive. Then when I checked my insurance, Ozempic and Mounjaro are super cheap, like $35/month, but Wegovy is almost $800! Zepbound isn't covered at all!
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That's pretty common. My insurance is the same way - they'll cover Ozempic and Mounjaro if you have type 2 diabetes, but not for weight loss.
 
I see a weight loss doctor, and my insurance covers the visits. She prescribes me a compounded semaglutide from a local pharmacy. It's about $65 each month, $80 with shipping. It's a good option!
 
Started at 256 in April 2023. Hit 204 now, aiming for 178. Insurance covered Wegovy for a bit then dropped all GLP1s, so I switched between research semaglutide and other options. Tirzepatide is working at about 4 lbs a month.
 
Switched from name brand to compounded but costs ballooned. Insurance dropping me was discouraging but stepping back a few months actually reset things. Started again last month and boom - working like it did at the beginning.
 
Good tip, gonna check that out. Insurance pens at 25 dollars monthly are hard to step away from. Collecting and reusing isn't bad though, worth looking into.
 
Congrats on hitting your goal! I restarted a couple weeks back after losing coverage and having the weight creep back. Still feeling sluggish so far but seeing someone with the same starting point reach their target gives me a real shot of hope.
 
quit cold turkey and gained 8 lbs the first week. my doc threw phentermine at the hunger problem while insurance fought us. three months off, blood sugar started dipping bad in the afternoons. a1c crept back to pre-diabetic. finally said screw it and started the pill version to save money.
 
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