Susan Maria Leach
Founder of Bariatric Eating
Author Before and After - Living & Eating Well After Weight Loss Surgery (HarperCollins Publishers)
It's very confusing at first and even overwhelming. Semaglutide, Ozempic, Wegovy, Tirzepeptide, Mounjaro and Zepbound... how do you know which one is the right one or even which one is covered by your insurance, if any of them. How much are they? Where to even begin?
It took me a while to sort it all out, and thats why your old familiar bariatric best friends decided to start a new group on Facebook and help people who are stuck in Bariatric Surgery Mode find their way out of the hole! I have also given you a few steps to begin your quest for GLP1 meds to read as well as asking in our group. Read below and then ask away.
Click to Join GLOW Bariatric Chat for Zepbound™, Mounjaro ™, Ozempic™, & Wegovy™ on Facebook.
How do I get my hands on GLP1 medications?
Ozempic (which is Semaglutide) and Mounjaro (which is Tirzepatide) were developed and tested for Type 2 Diabetes management. If you have diabetes, these may be covered by your insurance.
Ozempic rebranded for weight loss is called Wegovy. Mounjaro rebranded for weight loss is called Zepbound.
If you dont have diabetes, your first step is to call the 800 number for your health insurance to ask if weight loss medications, specifically Wegovy and or Zepbound, are covered by your plan.
Weight loss meds are not usually covered by insurance plans, but you just may be lucky. You can also log on to your insurance website or app and read your plan benefits - the excluded benefits are usually listed towards the end where you may see Weight Loss listed. Then you know it is excluded and will need a different path.
Why doesnt my insurance cover these medications if obesity is a disease?
Most private insurance companies and federal health programs don’t cover weight loss drugs and Wegovy and Zepbound each cost $1,000 or more per month out of pocket. In short, they are expensive and adding to the cost, people typically need to take the drugs indefinitely to keep weight off.
My friend has Blue Cross Blue Shield and her Ozempic is covered. Mine is not! What gives???
If her Ozempic is covered by her health insurance, she most likely has Type 2 diabetes. Remember that Ozempic is foremost a diabetes medication and therefore is more likely to be covered.
Also, multiple versions of health insurance policies even with the same company are not the same. It's the employer that determines which policy it offers workers and even what the policy covers. Some employers are offered policies that cover more aggressive therapies such as weight loss and some are not. Just as one Aetna policy has a cost to you of $350 a month for an HMO with a $5000 deductible and another Aetna policy costs $2500 a month for a PPO with a $1000 deductible, they are not the same policy, nor are they even close as to what is covered, the max out of pocket costs or the deductibles. They are not similar in any way.
This is why comparisons, even to other people who have insurance with the same company are moot, they mean nothing. This makes it impossible to find out which companies may cover the meds you want.
Bottom line, is that very few insurance plans cover Wegovy and Zepbound for weight loss. Many cover Ozempic and Mounjaro for diabetes but sometimes only after you have tried several other diabetes management drugs in a process called step therapy, but at least there is hope to work your way through other meds to the new ones we all want.
Do you have health insurance that will not cover GLP1 meds but are able to budget about $500 to 600 a month?
If you are able to self pay for an average of $550 a month, you can get a prescription for Wegovy or Zepbound for weight loss through your primary care doctor and get it filled at a local pharmacy. If you do not feel your primary care doc will be obesity med friendly and will simply lecture you about diet and exercise, it can be less stressful to use an online telemedicine provider that is very familiar with these medications to guide you to a prescription appropriate for your specific medical situation.
We encourage you to look to Mochi Health (JoinMochi.com) as your online provider for comprehensive obesity medicine. Their board certified obesity physicians and registered dietitians are ready to work with you with one click telemedicine visits to build a plan that fits your goals and determine which medications will work for you and your budget. They will also contact your insurance to see if they can possibly obtain approval for coverage.
If you do not have health insurance, or If these medications with or without insurance coverage are still too expensive, then what?
Compounding may be the answer for you.
As a safe and effective alternative to brand name medications, patients without insurance or who have been denied coverage have the option to pursue compounded medications of some of these incredibly effective medications for obesity.
You must obtain a prescription for compounded versions of GLP1 drugs from a qualified provider with an established business relationship with a compounding laboratory. We again strongly encourage you to look to Mochi Health (JoinMochi.com) for guidance with compounded medications - Semaglutide rather than Ozempic/Wegovy and Tirzepatide rather than Mounjaro/Zeptide - all work as well as the branded versions for substantially lower cost. Via Mochi Health, compounded lab Semaglutide is $175 a month and Tirzepatide is $325 a month.
Are there other options that may be even less expensive?
Yes! While not as hyped in the media as Ozempic and Mounjaro, there are other meds you can use. Qsymia and Phentermine, are prescription medications that will also safely work to calm appetite and hunger and help you to lose weight. We have administrators who have chosen this path and can help you just as thoroughly as of us taking and specializing in Ozempic, Wegovy, Mounjaro, Zepbound and compounds. We cover them all, along with lifestyle changes to maximize use of the meds!
We are available to help you in real time with any questions in our Facebook Group.
Click to Join GLOW Bariatric Chat for Zepbound™, Mounjaro ™, Ozempic™, & Wegovy™.
