Can some please explain to me why it is that your health insurance can deny you medication, even if your doctor says you need it?

Submitted ⁨⁨21⁩ ⁨hours⁩ ago⁩ by ⁨KuromiGirl04@lemmy.world⁩ to ⁨nostupidquestions@lemmy.world⁩

Let me explain with my current situation. I am 22 F and I currently weigh 305lbs.

I am obese. Morbidly obese.

Even though I have been trying for 5 years at this point to lose the weight on my own. Eat healthier, eat more fruits and veggies, cut out excess sugar, walk more, exercise more, the whole kit and caboodle.

But I still am not losing the weight. I am still very fat. And I am worried that it will cause very serious health problems.

So I talked with my doctor and she told me “We need to get you on a weight loss medication. Let’s try Ozempic”.

But my insurance told us that they don’t think I need the Ozempic so they won’t pay for it.

So we tried Wegovy and Mounjaro. But my insurance still rejected our requests.

They’re saying because I am young, and I am a diabetic with good numbers, I dont need the weight loss meds and I can just lose the weight naturally.

But ive been trying to and it hasn’t been working. So that’s why my doctor prescribed me the weight loss med.

Why is this allowed? Why is it that your insurance can deny you a medication, even if your doctor says you need it?

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AA5B@lemmy.world ⁨1⁩ ⁨hour⁩ ago
The is healthcare system is clearly a disaster but …. Since those drugs are not approved treatment for a health issue you have (your diabetes is under control), they have. Bit of an excuse. The real reason of course is that most of the population is overweight so they can’t afford to pay for everyone who needs it.

Can I suggest other strategies that may help you lose weight?

When I was planning to have kids I successfully lost over 100 pounds and kept it off for a decade! For me the key factors were doing it with my wife so we kept each other on track and food tracking. We joined weight watchers but it was the food tracking that made the difference for me and there’s many ways to do that. Even when you think you’re doing well you probably consume a lot more calories than you think, and it adds up. Food tracking can highlight this, identify where to make more effort. On the other side of things, losing weight requires following good habits over time: food tracking also helps you stay on track over time but this is also where peer pressure from someone else can really help.

Of course I’ve gained it all back now that my kids are in college but I did pretty well for their entire childhood, which was my motivation. I currently may have better nutritional habits than I did back then but I’m clearly way off in portion size and calories consumed

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Geth@lemmy.dbzer0.com ⁨2⁩ ⁨hours⁩ ago
Hey OP, I will copy a point I made somewhere deeper in this thread that you might not see, because I do really believe that there is help to be had. I commend you on your desire to do something about this, since it will increase your quality of life in ways you never even imagined. Other people have also had great points I think and have touched on the tragedy that is the US medical system, I want to touch on the potential alternative solutions that are too often overlooked.

The obesity epidemic is caused by caloric density creeping up in ultra processed foods, tricking people into thinking they eat a normal amount when they most definitely don’t. The fact that these foods are almost like a drug for some brains combined with the fact that some bodies struggle more than others with burning calories can make it more difficult at first for people to loose weight, but you find yourself in the difficult circumstance of having to pay 200$ per week to do something about it, and there are two alternatives.

“Eat healthier, eat more fruits and veggies, cut out excess sugar, walk more, exercise more, the whole kit and caboodle” - as an external observer with no context all I can read from this is that you replaced some unhealthy calories with some healthy calories. So the first proposal is calorie counting by yourself. You have to be anal about it, every little detail, any little snack has to be on your list and fully counted. If you do this properly and have a hard limit of 1500-2000 per day you will absolutely see results without having to do any excercise or eat any specific food. This is proven science at this point and anyone arguing about this is trying to sell you something or someone else sold them something. More colorful trends like intermittent fasting also achieve caloric deficit in a roundabout way, but in the end it doesn’t matter what approach you take, any way that works for you is fine, as long as you don’t go over the caloric limit. Losing weight is not exciting and doesn’t have some funny quirky solution, it’s just simple hard brute force.

Second, a little less brute force solution, but also not free, spend a fraction of that ozempic money on a registered dietician that can monitor your intake and make recommendations. At least that way there’s external support and motivation, as well as much needed help in case you have a history of eating disorder. I found they are like 100-200$ per month so an 8th to a quarter of the ozempic price. This is still going to be hard work, but with support and help from an expert it will be far easier to establish and maintain.

Both of these solutions will help build good habits and help you build an intuition for food caloric content at a glance. Ozempic, if it works, skips these important aspects, which might make you rebound after finishing the treatment, since you never actually learned how to manage your intake, just had reduced appetite for the duration of the treatment. Any aditional things you do like eating healthier and exercising will be a great bonus to your health, but you should honestly skip if they are overwhelming you and impeding you from achieving your goal. It’s normal to expect failure when the requirements are steep, so keep it a level you can manage. If calorie restriction is all you can do, then stick to that, but don’t compromise it ever because that is the absolute minimum. Everything else may come later.

I wish you good luck with your journey and hope you’ll enjoy the new life when you finally succeed.

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lightnsfw@reddthat.com ⁨5⁩ ⁨hours⁩ ago
Because your congressperson is bought and paid for and there aren’t enough people assassinating health insurance CEOs in the street to inspire them to change their ways.

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sp3ctr4l@lemmy.dbzer0.com ⁨3⁩ ⁨hours⁩ ago
The health insurance industry is an objectively evil but very profitable business model, that sustains itself directly on human misery.

This is allowed because our government is corrupt, paid off, and broadly dysfunctional, and/or controlled by ideological/religious extremists who hold bigotry of one kind or another as a fundamental principle.

This is allowed because exploiting your suffering makes a small number of people very wealthy.

And that small number of people runs everything by way of paying off nearly everyone involved in potentially regulating them, nearly every elected representative at the level of State government or higher.

You live in a failing, rogue, totalitarian, extremist state, run by pedophile rapist murderers who lie openly and brazenly every day.

You do not live in a well-run, representative democracy, that sees to the needs of its citizens.

You live it’s corpse.

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TheObviousSolution@lemmy.ca ⁨5⁩ ⁨hours⁩ ago
It’s not allowed, but then again, I’m not in the US.

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Adulated_Aspersion@lemmy.world ⁨8⁩ ⁨hours⁩ ago
Nunber 1: Ozempic is NOT a weight loss drug.

Ozempic is a diabetes management drug that has a potential side-effect of weight loss.

The reason that you are likely being denied for Ozempic by your insurance is because you likely lack the diabetes with the additional comorbidities. You shared that you are diabetic with good numbers.

If you had worse diabetes and additional issues (comorbidities) such as high risk for stroke or heart attack by (very) high unmanaged blood pressure, then you could appeal the insurance company to cover the drug.

Number 2: the struggle is real. I highly recommend you fight this and continue your weight loss journey. Diabetes is unbelievably complicating later in life.

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- SaveTheTuaHawk@lemmy.ca ⁨7⁩ ⁨hours⁩ ago
  US healthcare will go broke covering $350/mo drugs to counteract lifestyle choices. 15M already on this drug, that’s $5.25B a month.
  
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  - Shayeta@feddit.org ⁨6⁩ ⁨hours⁩ ago
    It doesn’t cost $350/mo/person to produce these drugs. Manufacturers brazenly price gouge knowing no goverment body would retaliate.
    
    This is a problem that can be solved by legislation and cutting out the middle-man(insurance companies) by expanding medicare for all.
    
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  - vithigar@lemmy.ca ⁨7⁩ ⁨hours⁩ ago
    Damn, so five whole days of the Iran war would cover it for a whole month for everyone?
    
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  - shaggyb@lemmy.world ⁨5⁩ ⁨hours⁩ ago
    Good. Fuck em all and replace the whole thing with a system that works.
    
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  - gravitas@lem.ugh.im ⁨7⁩ ⁨hours⁩ ago
    Oh no! Not the health~~care~~ insurance industry.
    
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actionjbone@sh.itjust.works ⁨21⁩ ⁨hours⁩ ago
It’s quite simple:

They are money-grubbing assholes in an unregulated industry. Their goal is to make as much money as possible while hurting as many people as possible. Because if they hurt people, they can take their money and provide no service.

It’s legal because the government won’t make it illegal.

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- cymbal_king@lemmy.world ⁨9⁩ ⁨hours⁩ ago
  They argue that they are preventing waste and fraud by holding doctors accountable. Like “oh if we didn’t have this power then doctors would order so many unnecessary tests and prescriptions”
  
  (Not defending them, just sharing what they say)
  
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  - captainlezbian@lemmy.world ⁨5⁩ ⁨hours⁩ ago
    If that was the case we’d have one of the most efficient medical systems in the world instead of one of the least
    
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  - actionjbone@sh.itjust.works ⁨7⁩ ⁨hours⁩ ago
    Yeah, and what they say is bullshit. Doctors prescribe the medicine people need.
    
    They don’t care about fraud. They care about their profits. We shouldn’t repeat their excuses like that.
    
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chunes@lemmy.world ⁨1⁩ ⁨hour⁩ ago
Something I’ve noticed is that doctors like to offload saying “no” to insurance companies so they don’t have to do it themselves. That’s at least part of it.

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whotookkarl@lemmy.dbzer0.com ⁨20⁩ ⁨hours⁩ ago
The insurance company is going to have a doctor who said you don’t need it. They will try to hide who that doctor is, specifically what their NPI is, which can be used to personally identify the doctor who made the medical judgement against your doctor’s without having to provide further explanation than they’ve already given. Depending where you are they may have to provide more information when directly asked for specific evidences, or will suddenly change their rejection on the claim with a letter from an attorney asking for specific details in writing. They know hiring an attorney is expensive and bank on people not advocating for their rights & people with severe medical issues not being able to afford to.

a list of things to request from your insurer that may cause them to charge their determination

And lastly a video of a surgeon being denied the NPI of the insurance’s doctors who are likely breaking the law hiding behind the idea that insurance doctors are so hated they need to hide their identity even from other doctors to prevent reprisal. She was blacklisted from United claims for this video and others like it.

youtu.be/AZhCYisIQB8

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- AmbitiousProcess@piefed.social ⁨15⁩ ⁨hours⁩ ago
  
  The insurance company is going to have a doctor who said you don’t need it.
  
  To add on to this, my psychologist told me that he’s had antipsychotic meds denied by a urologist before, because the insurance companies often don’t actually care what field the doctor is in. All they care about is getting to say “a doctor” reviewed it.
  
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  - uberfreeza@lemmy.world ⁨3⁩ ⁨hours⁩ ago
    I have a relative who is a doctor. Had a claim denied once from someone that was not a doctor. Next: denied by someone not actively practicing in the field. Then denied by a doctor with no experience in that specialty. Only after all of that was it approved. They’ve also been picky about order of operations, such as not covering an MRI because there wasn’t also an order for a CT.
    
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  - Adulated_Aspersion@lemmy.world ⁨6⁩ ⁨hours⁩ ago
    And you can leverage that in your appeal letter.
    
    Especially when you have a pissy provider who doesn’t like being told “no.”
    
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  - Tollana1234567@lemmy.today ⁨15⁩ ⁨hours⁩ ago
    then they have teams to review the first insurance agent approved your medications, and sometimes a team to review that teams decision of said medication. they will do this til you give up.
    
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- CileTheSane@lemmy.ca ⁨4⁩ ⁨hours⁩ ago
  Isn’t the insurance approving the medication/procedure only after being asked for proof the denial was legally obtained evidence that the denial was illegal, and reason enough for a lawsuit?
  
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- yakko@feddit.uk ⁨16⁩ ⁨hours⁩ ago
  This is the lore. I haven’t heard from anybody trying it, I hope OP will make the attempt and report back.
  
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Heyla@quokk.au ⁨4⁩ ⁨hours⁩ ago
Because capitalism and culture of inequality

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obelisk_complex@piefed.ca ⁨20⁩ ⁨hours⁩ ago
Oh, I know the answer to this one. It’s because we don’t have single-payer healthcare, which Republicans don’t want because they don’t want bureaucratic death panels of disconnected doctors denying people access to medication.

They’d much prefer to have bureaucratic death panels entirely disconnected from any medical expertise denying people access to their medication and for spurious reasons.

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Bristlecone@lemmy.world ⁨16⁩ ⁨hours⁩ ago
Nurse here. Because in America our healthcare priorities are FUCKED that way. Getting worse every year too

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- Tollana1234567@lemmy.today ⁨15⁩ ⁨hours⁩ ago
  isnt also because alcohol industry is lobbying against it, because omezpic also reduces your “desire” for drugs.
  
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  - SaveTheTuaHawk@lemmy.ca ⁨7⁩ ⁨hours⁩ ago
    and McDonalds.
    
    no way this skinny CEO eats that shit.
    
    Image
    
    He swallowed some of the juice, he’ll taste that for weeks.
    
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gravitas@lem.ugh.im ⁨7⁩ ⁨hours⁩ ago
Look into compound pharmacies, you can get it for under $50 a month that way and not have to deal with insurance at all.

Sorry you are getting such negaticve responses here, people dont realize ozempic actually helps you to eat less and make the lifestyle changes people insist anyone can do without help. Feel free to dm me if you need additional help.

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GlenRambo@jlai.lu ⁨11⁩ ⁨hours⁩ ago
Sadly that’s only (or mostly) in America. Here we get whatever meds the dr says. Most common ones are subsidized by the government (via taxes yes).

My idea of Ameroca was already wild but finding out you gotta convince an insurance company you pay that you need medicine a dr prescribes is crazy.

Oh and we get pretty much all blood tests and stays for free. GP one day, scan/test the same day (different location but some have them next door) then back at the GP by the end of the week with results and get your meds. Done.

Sorry OP.

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imetators@lemmy.dbzer0.com ⁨8⁩ ⁨hours⁩ ago
Money.

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doesit@sh.itjust.works ⁨10⁩ ⁨hours⁩ ago
Luigi…

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UnderpantsWeevil@lemmy.world ⁨4⁩ ⁨hours⁩ ago

Why is this allowed?

It’s a private company operating under a contract that affords representatives to deny you payment for care on conditions that favor the company.

Why would it not be allowed?

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Witchfire@lemmy.world ⁨21⁩ ⁨hours⁩ ago
The reason is what pushed Luigi to merc one of them

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- lemmyng@piefed.ca ⁨21⁩ ⁨hours⁩ ago
  What do you mean, Luigi was at my place playing xbox games when that guy got killed.
  
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  - neidu3@sh.itjust.works ⁨20⁩ ⁨hours⁩ ago
    Can confiem. I was playong with both of them online, and Luigi and I were making lewd comments about lemmyng’s mom.
    
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melsaskca@lemmy.ca ⁨10⁩ ⁨hours⁩ ago
Because “business” and “dollar amounts” are more important than human life (some human life anyway).

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EveryMuffinIsNowEncrypted@lemmy.blahaj.zone ⁨18⁩ ⁨hours⁩ ago
Money and the power of “fuck you”.

:(

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HubertManne@piefed.social ⁨6⁩ ⁨hours⁩ ago
Im going to go out on a limb and assume you are from the us. us healthcare is nuts. Here is the funny thing. My wife has thyroid issues. Her bloodtests shows it within normal but on the low end. Doctor refuses to raise her cheap thyroid medicine and instead insists on a gpl. Even though she has other symptoms for low thyroid. insurance we had did pay for it. it makes no fucking sense. at times we can’t get stuff we need and at others we are given options we don’t want. A similar thing is there is this pretty cheap procedure called prp where they draw blood and centrifuge it down and dake the serum and inject it in a joint and it seems to relieve pain and does so for awhile. Like she could just get it once a year. They would not cover that but they did at one time. It kinda was based around what medicare was doing. They will pay for surgery that from our experinece may or may not make it better and may make it worse (we have more experience with surgery than anyone would want to have). That surgery is so expensive that if you were to stick the cost into a savings account it would easily make interest enough to do the prp. So even economics wise the insurance company should do the prp. Why don’t they. Because its like a game of chicken. people may get surgery but it does not always go well so many people will not get it. Also prp is done in the doctors office and does not require anything. They will pay for things from drug companies injected into the joint. We have just the worst system. Also you know why your insurance covers some things but not others? Some high muckity muck at your company want something. We had one that did unlimited chiro. Im like 100% the president or one of his family must get chiro adjustments every week or something. Either that or someone between the president and the hr level that decides on what insurance to use.

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FartMaster69@lemmy.dbzer0.com ⁨14⁩ ⁨hours⁩ ago
The answer is evil greed.

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BarneyPiccolo@lemmy.today ⁨9⁩ ⁨hours⁩ ago
These drugs were originally diabetes drugs, that had the side effects of weight loss, but that wasn’t their original use that they got FDA approval for.

So they are going back and getting them approved for different uses, and maybe one of those will get by the insurance company. I saw one being advertised for Sleep Apnia, which is common in obese people. It works because when you lose weight, your Apnia usually improves, so while they aren’t selling it specifically for weight loss, that’s the mechanism that improves the Apnia. Maybe your doctor can get it approved for that reason, or another one.

I was 350, and I’ve lost 100 pounds, without the drugs. I quit all sugary beverages, and only drink ice water or unsweet tea. I only eat when I’m hungry, and only until I’m not hungry. It allows me to eat whatever I want, but in strict moderation. It doesn’t feel like a diet, though, because when I’m hungry I eat, but only until I’m not. I never eat more than a half sandwich. I will eat cookies, but only two, not half a package. When I have craving for chocolate, I’ll eat 4 or 5 chocolate chips, one at a time, and let them melt on my tongue, so my chocolate craving gets fulfilled, without an entire candy bar.

And importantly, I developed a distraction. My Dad quit smoking years ago, by doing a Rubik’s Cube whenever he got a craving. I took up the guitar. I keep an acoustic guitar next to my chair, and if I get a craving, instead of heading to the fridge, I pick up my guitar.

I didn’t even increase my exercise, although I have a pretty physically active job. I’ve plateaued now, so I think it’s time to increase my exercise for the last 50 I’d like to lose.

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- captainlezbian@lemmy.world ⁨5⁩ ⁨hours⁩ ago
  I’ll add that one huge thing is establishing a realistic plan that accepts weakness and failures without derailing. When I was actively losing weight I did the following cico based plan.
  
  I started with a week of just counting calories, all diet changes were because I was aware of how much I was eating. While doing that I found out what my maintenance calories were and what the maintenance calories of my goal weight were.
  
  I then did a week at my maintainance calories, though the goal is to keep doing it until it’s comfortable. While doing that I figured out general meal plans (ie how much I wanted to budget for breakfast/lunch/dinner/snacks). This stage is important because a) you’re probably used to overeating so this is you stopping gaining weight, b) you’re learning where you’re most comfortable cutting calories in your day, and c) relearning your relationship with hunger. For that last part, I was teaching myself to associate a mild hunger with losing weight and to stop seeing it as such a problem.
  
  Then once I was comfortable at maintenance I began with a 500 calorie deficit. That’s a generally safe number that’s largely achievable and results in a pound a week loss. When I was comfortable there I moved up to 1000 a week, which is about the limit of what is safe/wise for the average person to sustain over an extended period without medical supervision. Either as the ultimate deficit is fine.
  
  From there, don’t check the scale more than once a week, and if you hit a plateau for a few weeks reevaluate your maintenance calories and double check you aren’t missing some in your counts. I also recommend smaller portion sizes over a longer time. Keep food out of sight when it’s not eating time. Try a glass of water and a walk instead of a snack. You may need a multivitamin or to plan around your micronutrients. Fiber helps with satistion, refined sugar hurts with it, though you’ll figure out what foods leave you full and what foods just aren’t worth the calorie/fullness ratio pretty quickly. Some days you will fail, that’s ok, keep them spread out and don’t try to make up for them. You can have cheat days, but those calories do still count so keep them few and far between. Also home cooked is usually a better value for calories than premade.
  
  Once you hit your goal keep counting while eating at maintenance for a while to ensure you’re sticking with stable maintenance habits. This isn’t supposed to be a yo yo (though if you’re active dirty bulk/cut cycles), instead it’s about building a healthy relationship with food portioning.
  
  Exercise doesn’t make you lose weight outside maybe a hundred or two calories a day, but it does lead to a healthier lifestyle and creates reinforcement of the health and ability gains from weight loss. It also can raise your resting calorie burn (don’t calculate for changes from it until you’re done). The important thing is just like with diet, finding a way to sustain it. This means finding something involving cardio that you enjoy that you can do regularly like a sport, running, or biking. If you’re interested in strength building, bodyweight exercises are great. Slowly build up with exercise, until you’re at an activity level that you want.
  
  Anyways yeah, I figure it’s worth putting all this out there since a lot of people out there love to act like it’s either all about willpower or all about finding tricks to not need any willpower, when really it’s all about building better habits and accepting that it took time to gain it, it’ll take time to lose it, but you lose it bit by bit with actual changes. I was never huge, but I lost 30 pounds in about half a year when I was OPs age and developed a healthy lifestyle for years out of it despite a family riddled with obesity, heart disease, and anorexia.
  
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  - BarneyPiccolo@lemmy.today ⁨4⁩ ⁨hours⁩ ago
    Losing weight is just math: Calories In vs Calories Out. Which one is bigger determines whether you gain or lose weight.
    
    For that last part, I was teaching myself to associate a mild hunger with losing weight and to stop seeing it as such a problem
    
    This is huge, and one of the first things that you have to overcome. Heavy people have been conditioned to not just eat when they feel the slightest hunger, but to stuff themselves. Making that psychological shift that a little hunger is not only acceptable, but it’s a signal that you are losing weight, is a sign that your diet is working. After a while, instead of motivating you to go to the refrigerator for something to eat, that hunger reminds you of your weight mission, and motivates you to stay the course.
    
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mech@feddit.org ⁨16⁩ ⁨hours⁩ ago
Because there aren’t enough Nintendo video game characters advocating for a change.

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Rhynoplaz@lemmy.world ⁨21⁩ ⁨hours⁩ ago
My wife was prescribed one of those for her diabetes, and the insurance company STILL wouldn’t cover a dime. She was able to find a coupon for a three month supply for $350.

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- KuromiGirl04@lemmy.world ⁨21⁩ ⁨hours⁩ ago
  And see, that’s what my problem was
  
  Yes, I am technically a type-2 diabetic, but i am a diabetic with good numbers, so my insurance is saying "oh we wont pay for those meds. You don’t need it."🙄😒
  
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  - Jack_Burton@lemmy.ca ⁨19⁩ ⁨hours⁩ ago
    Unfortunately, the answer is to move to a country that’s not a shit hole and has universal healthcare. The next best is to do what you can to survive while you try to convince people to vote with you for a gov’t that will give you universal healthcare.
    
    Right now? I can’t imagine what you’re going through and I really am sorry I can’t help directly. Your system is broken. Your gov’t has failed you. I really, truly and honestly, wish you the best and hope you find the help you need.
    
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  - mech@feddit.org ⁨14⁩ ⁨hours⁩ ago
    Then you gotta pump those numbers up, those are rookie numbers!
    
    (pls don’t)
    
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- starlinguk@lemmy.world ⁨15⁩ ⁨hours⁩ ago
  Three months for 350 is pretty good, here it’s 500 a month.
  
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Fubarberry@sopuli.xyz ⁨21⁩ ⁨hours⁩ ago
You can get wegovy 28-day of the auto injectors through Amazon pharmacy for $200 a month without insurance. It still requires a prescription, but it sounds like you have that.

Obviously it would be better if your insurance would cover it, but $200 a month is better than the $600 a month some people are paying for ozempic/etc.

When signing up for insurance, you’ll want to check their approved medications. My wife was prescribed mounjaro for her diabetes, but most of the insurance plans we looked at didn’t have it listed as one of their approved medicines. It was one of the largest factors in deciding which insurance we needed to go with.

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- Tollana1234567@lemmy.today ⁨14⁩ ⁨hours⁩ ago
  apparently you can use coupons for the pharmacy in amazon to lower the price evenmore. i wonder of goodrx works on it.
  
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  - captainlezbian@lemmy.world ⁨4⁩ ⁨hours⁩ ago
    Clown ass country where we need coupons for medicine
    
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Nemo@slrpnk.net ⁨21⁩ ⁨hours⁩ ago
They can’t, they can only deny coverage for it. You can still get it paying for it yourself.

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- KuromiGirl04@lemmy.world ⁨21⁩ ⁨hours⁩ ago
  Yeah, paying $200+ a week for a shot. In this economy?
  
  I don’t know anyone who has that kind of money
  
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  - ccunning@lemmy.world ⁨21⁩ ⁨hours⁩ ago
    I just went through this battle myself. And my insurance even approved it, but I’m traveling overseas for two months and even though they tell me my benefit covers a “vacation override” they wouldn’t approve it.
    
    I asked the pharmacy how much it would cost to pay out of pocket. $1300 for 4 weeks, so $2600 to cover my trip.
    
    Luckily my Dr was able to give me “samples” to get me through my trip.
    
    Also, another thing that I learned in the past year. What your insurance will cover and how much they’ll cover changes depending on your history.
    
    Spend a three day weekend in the ER/ICU and suddenly I DO need Ozempic and they’re giving me thousands of dollars worth of CGMs for free.
    
    It’s all a cost/benefit analysis for them.
    
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  - BurgerBaron@piefed.social ⁨20⁩ ⁨hours⁩ ago
    The intended goal of conservative voters is to ignore your plight and they’d like you to die off screen.
    
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  - Tollana1234567@lemmy.today ⁨15⁩ ⁨hours⁩ ago
    imagine trying to get approval for biologics, which can thousands a month.
    
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  - Nemo@slrpnk.net ⁨19⁩ ⁨hours⁩ ago
    I’m not saying it’s right, I’m just saying it’s so.
    
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  - Munkisquisher@lemmy.nz ⁨20⁩ ⁨hours⁩ ago
    Here in NZ it’s less than usd $300 a month full cost, but usually funded by the govt.
    
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- actionjbone@sh.itjust.works ⁨21⁩ ⁨hours⁩ ago
  Not always. Sometimes, companies won’t sell it to you if your insurance has denied it. They may say it’s because they don’t believe you can afford it.
  
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Corkyskog@sh.itjust.works ⁨21⁩ ⁨hours⁩ ago
Capitalism and actuarial science. Their models likely show that you are still young enough for them to keep you fat for a few years while the cost of GLP1s go down.

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jakemehoff11@sh.itjust.works ⁨20⁩ ⁨hours⁩ ago
Mounjaro and Ozempic both have savings cards you can sign up for on their respective websites, as long as you aren’t on government insurance.

I had the same issue last year, my A1C was 6.9 and insurance denied coverage. I got the savings card from Lilly, had my doctor call in the script and BAM! 25USD for 12 weeks of Mounjaro.

I didn’t even need a prior authorization anymore. Apparently results may vary, but I got lucky. Try them both if needed. Stay vigilant!

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- KuromiGirl04@lemmy.world ⁨16⁩ ⁨hours⁩ ago
  I am on government insurance.
  
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- Tollana1234567@lemmy.today ⁨15⁩ ⁨hours⁩ ago
  they recently stopped covering glp-1 and similar for state subsidized healthcare, seems to coincide with it being lobbied against recently in congress.
  
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Tollana1234567@lemmy.today ⁨15⁩ ⁨hours⁩ ago
it simple, they wont pay for expensive ones at all. brand names, they prefer you to take generics over it, even if its a different type of generic.

Also insurance may have tiered system for certain drugs, the lowest being generics, the 2nd one being brand name of gernics, and then expensive generics would be the next tier, or brand names that dont have generics.

its when you get to things like biologics, or speciality drugs things get super expensive.

Ozempic addicts ruined it for people who need the drugs.

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