Losing insurance, scared about meds!

Hong Kong Yanpep International
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Calorie_Coffee

Active member
Hey everyone, I've been on metformin and Lantus for my type 2 diabetes, and it's been pretty stable. My doc mentioned trying GLP-1s, thinks it could help even more. But I'm seriously freaked out about insurance. I've heard horror stories where people's coverage gets cut or changed.

My work isn't giving me clear answers about what they actually cover, and that's stressing me out. I need these meds to stay healthy, and I'm scared of getting stuck with huge bills – I've seen some GLP-1s can cost over a grand a month without insurance. I'm seriously worried about choosing between my health and emptying my bank account.

Has anyone dealt with losing coverage for their diabetes meds? I'm looking for advice on:

* Patient assistance programs
* Appealing coverage decisions or finding other insurance options
* Ways to lower med costs

Any tips or experiences would be a lifesaver!
 
I have heard of people getting Metformin and insulin, and almost anything else you need, from overseas for crazy cheap. You use a messaging app and a money transfer app. If you are okay with it, supposedly the Chinese sources are even better for the GLP's. Just be aware of long ship times.
 
Yeah, dig around on this site for info on buying "kits" (boxes with multiple vials at the stated dosage) from online places. Search by the generic name of whatever injectable you're using.

Just know it'll be a powder, so you gotta get the right kind of sterile water and syringes separately. Do the math (or use a calculator; see my signature). And probably use crypto.
 
Okay, I'm probably gonna get flamed for this.

Calorie_Coffee, easiest way to get Ozempic or Mounjaro is insurance AND a T2D diagnosis. Same with Medicare. Script has to be for T2D, NO mention of obesity. But if it's not on your formulary, it's a no-go.

If you're T2D, push for the insurance route. If you go the other route, your doctor needs to know you're managing your diabetes with a GLP-1, otherwise your tests will look like you're not even diabetic.

My T2D is from a transplant, and I get my Mounjaro every month through Medicare, even though it costs me more than the alternative due to copays. But it's helped me so much that my doctors have adjusted my other meds. I still get it from other sources too, just in case. I alternate between the two. Because I've been on it since last year, I think I fall under "continuity of care," so I didn't get denied when my insurance renewed. I hope you have the same luck.
Calorie_Coffee said:
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Just wanted to give everyone some hope! I hit my out-of-pocket max already this year. Kinda sucks that it cost me so much so early in the year, but at least everything else will be "free" for the rest of the year!
 
Just took my last dose of Mounjaro today. I'm also diabetic and have been on it since late 2022. Sadly, my insurance changed, so I might switch to Ozempic if I can swing it. Tricare can be a pain with approvals. My A1c is at 5.4%, used to be 11%! I was diagnosed in 2021.
 
That's fantastic progress, Juice_FWIW! Congrats on the improved A1c and weight loss. Tricare SHOULD cover both Mounjaro and semaglutide if you have T2D. Your doc needs to do a prior auth, but with a diabetes diagnosis, it should be fine. Liraglutide is also generic now; older med, but it helps some folks.
 
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