Some GLP-1 users have been able to win back coverage by pursuing every possible option in the confusing world of healthcare.
Appeal Lost Coverage
Bridget Roberts, 37, was reapproved for Zepbound by remaining patient and persistent. It started when the Pottsgrove, Pennsylvania, resident received a letter that her insurance company was no longer covering the GLP-1.
“Initially, I felt I was doomed,” she says. “Something was finally working for me, and I was more alive than ever, and they wanted to take it from me.”
Switch Diagnoses
Other GLP-1 users have successfully retained coverage by changing the diagnosis indicated on their prescriptions.
“Many GLP-1s are FDA approved for more than just weight loss, including type 2 diabetes, cardiovascular risk reduction, and even stroke prevention in certain populations,” says Supriya Rao, MD, a gastroenterologist and obesity expert at Integrated Gastroenterology Consultants in Boston.
If your insurer canceled coverage for a weight loss medication, it is possible that it will cover the same medication for a different condition, such as sleep apnea or heart disease. A new prescription for a new condition “can make the difference between full denial and full coverage,” says Dr. Rao.
Brianna Johnson-Rabbett, MD, an endocrinologist with Nebraska Medicine and a director of the American Board of Obesity Medicine, offers some examples. “If someone has established cardiovascular disease and is obese or overweight, Wegovy can be prescribed under that indication,” Dr. Johnson-Rabbett says. “If someone has moderate to severe obstructive sleep apnea and obesity, Zepbound can be prescribed for that indication.”
Switching diagnoses is no guarantee of coverage, however. “Insurance still may decide not to cover a medication, even if FDA indications for prescribing that medication are met,” says Johnson-Rabbett.
Search for Discounts
A variety of discounts may be available from the manufacturers.
The makers of Wegovy and Zepbound offer coupons and savings cards that can considerably lower your out-of-pocket cost for as long as one year. Not everyone qualifies for these programs, however, and they cannot be used indefinitely.
Read the full article here
