ZEPBOUND INSURANCE COVERAGE: GLP1 MEDICATION COVERED BY INSURANCE? Zepbound covered by insurance?

[@brianne571]

Sen Bernie Sanders is meeting with the CEO in the next month about outrageous prices in America. Costs $5 to make Ozempic. $60 is what Australia pays Canada in the $200s.

[@jamibeckham3243]

My physicians office had no idea how to pen a PA for Zepbound. After his PA and Appeal failed, I literally had to write it myself as a LOMN (letter of medical necessity), and it was approved! I included history, alt-medication contraindications, and the necessity for ZEPBOUND. A well written PA makes all the difference.

[@Teresa-jk6nj]

That's awesome!! Curious what insurance do you have? I have written a letter to BCBS and have been denied time after time. Congratulations to you that you are getting insurance coverage. Yay!😊

[@joinfridays]

Thanks for having me!! That was so much fun!

[@denise07-b2i]

i am taken back and touched by your approach - being cared for top priority (made me emotional). I want to hear more! Thank you Elizabeth for the opportunity to hear from this amazing person / founder / caregiver / human being ❤❤❤ just wow

[@Kelly-gt5wc]

I am so stoked that I have a Fridays appointment next Thurs. I have not been happy with the response of my current Telehealth. My primary is so supportive of my using a telehealth because she is not an obesity export and wants me to be an advocate for my health snd journey. Thank you for this information.

[@joinfridays]

Welcome 😊

[@dawnespino]

Finally, somebody that "gets" it. Starting at about 11:20. These drugs are life-saving for those of us who have literally tried everything. I would like to see the tide turning for public sentiment. I still see snarky comments whenever these drugs are discussed, "just eat less, move more." If that worked for those of use with metabolic dysfunction, do you really think that I'd choose otherwise?

[@joinfridays]

We will change the stigma together.

[@donnasanford3970]

Looking good in that beautiful color countess!❤

[@pamelaharbell9502]

How wonderful! Thank you for hosting these interviews and bringing awareness to this critical issue. I've joined Friday's and I'm so pleased. I have already been the route of requesting insurance, and submitting a grievance on my own, but now I realize that as a member of Friday's I'm armed with a bigger support team. Thank you for sharing this information. I didn't realize that Friday's could help with my insurance; how impowering to have this type of support. These drugs are truly life changing and life saving. E, thank you for all that you are doing.

[@Valley_Gal]

To date I have an amazing primary doctor-who has been so supportive, responsive and engaged in my journey even pre-mounjaro. But good to know that Fridays is there if I need them in the future.

[@Jennifer_xo_]

Me also! Am so thankful for my doc.

[@SheriJo27]

Loved this chat!! Thank you for always bringing the topics we all have questions about. You rock!!

[@cherieweber9468]

Thank you for this info. I’m starting my second month on Zepbound. Couldn’t get it at my CVS They said it’s very hit or miss so I ordered from a compounding pharmacy. The price was $270.00. They beat the brand name by a few hundred dollars, even with the coupon. I paid full price last month $1100.

[@lisamorrison4708]

can I ask what compounding company you go to and what does/ strength you receive for 270.? please

[@emilyhope7468]

Very good, informative session. Can you ask for those of us on Medicare if Join Fridays has been successful getting either Semaglutide or Terzepetide approved by insurance?

[@gracecunningham6261]

I am on Medicare and Medicaid. I'm a diabetic so they approved me with no problem. Edited...but I'm not with join Fridays. I guess I didn't read the whole message.

[@lindabookmiller8803]

Hoping to see a response to this! I’m all out of appeals and my Dr said they just aren’t covering any yet.

[@Valley_Gal]

He is so articulate 🎉

[@debp3810]

Just scheduled with join Friday's. I am so impressed with Dr. Arham that I've opted to change my telemedicine company. The offerings for the membership are priceless and I plan to keep it for a while even when I'm off of meds. Thank you so much for having him speak to us. Hugs and blessings Deb

[@CountessofShopping]

So happy for you! And cheering you on

[@joinfridays]

Thanks for your kind words!

[@debp3810]

​@joinfridays had my visit on Tuesday. OMG, I was blown away. My provider was so gracious and patient. Answered all of my questions and gave me answers to questions I didn't know I had. Only hiccup was the invoicing for the drug and that was a simple call to clarify that my provider ordered semaglutide. I am so excited to be with a company was clearly cares and is willing for me to work with my PCP while simultaneously working with her.🙏🏽🙏🏽🙏🏽

[@kbarnes617]

I LOVE THIS! I have my consult next Wednesday and looking forward to working with the Join Fridays team! ❤ Thanks Countess!

[@Dawned-13]

Just joined Fridays this morning.

[@joinfridays]

Welcome 😊

[@mtgplnrlisa]

Loved this - thank you so much!!!!

[@megalosing5900]

I would join but I do have a fantastic nurse practitioner. She just doesn’t have time to have support groups or one on one very often. I get one 15-30 minute visit every 4 months. Maybe one day I’ll join.

[@GRITSonthebeach]

I have the same situation. I have a great NP who worked hard with me to get Zep approved and so not want to change. I would love to add just the coaching element!

[@megalosing5900]

@@GRITSonthebeach yeah they also have a nutrionist call that looks great. I might join just for the Addons. But right now the support group is enough.

[@joinfridays]

We are here to support

[@GRITSonthebeach]

@joinfridays is there an option for nutrition guidance and emotional support without the medication management? I can not get compound drugs in the state of MS, and my GP, although wonderful, is not a weight loss specialist.

[@troutdale2]

Great discussion! Thank you! One thing I've been curious about is how someone who has been on treatment can seque into these organizations if no longer obese. It seems the intakes are frequently centered around current BMI, weight, etc. Do organizations like JF also bring people into maintenance regimens?

[@donnasanford3970]

That is a great question I’m at this point and terrified of gaining back weight and would love to begin a maintenance dose

[@joinfridays]

Hello! Fridays has a maintenance protocol. For patients whose BMI falls between a 22-26.9 who have been on anti obesity medications in the last 12 months, we can continue prescribing in most scenarios! As for whether insurance will cover medication for these patients, a different story all together.

[@joinfridays]

@@donnasanford3970we offer maintenance! Take the quiz to see if you qualify!

[@troutdale2]

@@joinfridays Thank you so much! That's excellent information to have. Appreciate the prompt reply :)

[@maryanncricenti8968]

This is just So Wonderful!!!! I would love to make an Appointment!!!

[@sunnyday2106]

Many get insurance to pay for mounjaro because of T2 diabetes. It is FDA approved for T2D. But how about people with pre-diabetes? Do I have to get my health worsen to T2D in order to get insurance coverage? Does this make sense to anyone? And this is healthcare in the greatest and richest country on earth?

[@brianne571]

Yes you do and they will probably give you metformin 1st?? $1000 is too much cost $5 to make provin by Havard. News came out yesterday everywhere. Sen Bernie Sanders tweeted this yesterday. He's meeting with CEO he's angry. COST $60 in Australia $200 in Canada!

[@emilyhope7468]

Makes no sense. I do know in 2019 I was diagnosed with pre diabetes and an elevated A1C. My doctor had no problem prescribing Ozempic. Now I'm not prediabetic and my A1C is normal, but rising since my last labs, and I cannot get approved. I've tried Mounjaro, Ozempic and Zepbound. I bet it's going to be the same with Wegovy., which was just approved by the FDA for heart disease. You have to currently have cardiovascular disease per my insurance (Humana) for them to approve.

[@aclaus596]

I want him to explain why we need blood panels. The reason I ask this is because I don’t have type two. So what else would they be looking for?

[@jodeski95]

This was done for me by pcp. They waited a year denying. Before it went to Appeal I became diabetic. Insurance approved in TEN minutes 😢. HUGE family history, Obese, 30 pounds gain over 2 years, silent MI, hyperlipidemia, OSA,CSA. Now oxygen dropping to 80s with CPAP. 96-100 during the day.

[@maryanncricenti8968]

Gorgeous Elizabeth💓

[@jeffkoons001]

I'm starting to feel that this is mainly sales channel -- Firdays, LMNT, etc.And you get commissions from these. I think you should be more transparent about this. I thought initially this was just a personal testimony thing, but it's really just an arm of your business.

[@KimmyGuitar]

She works very hard giving people information. She has massive amounts of info and she cheers people on amd motivates them! She should get a commission on some of the atuff she uses! She works very hard!

[@LMorrisette82]

I swear I never got an appeal from Friday’s. I even emailed as was like well what can I do next and was basically told nothing more to do. I had already to agree to be on compounds so I was wonder if that factored into their decision not to push forward.

[@CountessofShopping]

Pls email founder directly at sina (at) joinfridays (dot) com. (I can't put email into comments) I'm sure happy to help and handle. Hugs!

[@dianemcdiarmid171]

I am over 65 and my Insurance (Medicare Advantage--Blue Cross Blue Shield--Highmark) says that Insurance won't cover Zepbound or Tirezepatide because apparently there is a law that Medicare will never cover any weight loss medication!!!! :-( My physician wrote an Appeal twice and they still rejected insurance. It SUCKS. I am paying out of pocket well over $300 a month. I wonder why the hell I even have insurance, as I totally don't take any other medication. Ideas???

[@heatherrutherford4493]

Yessssss ❤

[@AnnDickinson-gw7oz]

What can we do when you are over 65, pre diabetics. I contested the refusal and had to use a compound trizepitide. The possibility of that going away is really stressful.There is no way I can afford Zepbound.

[@kristinbailey4357]

I have a question 🙋🏼‍♀️ I love that Join Fridays makes everyone get their blood work done, would you say that another positive when trying to get insurance to cover GLP1’s? Blood work shows proof of higher A1C and other markers.

[@janemarx1321]

I did this and Medicare part D turned me down flat out. I even sent in my lab trends on and off ozempic. I have to turn diabetic before they will cover anything. Back to Canada mail order.

[@aimeekreutzer-malkawi]

How much is Canada mail order

[@lindabookmiller8803]

Has Fridays had any luck getting any information on the latest report that Wegovy (and I assume soon Zepbound) has been approved for patients on Medicare Part D, diagnosed with heart disease? I called my insurance company and they had no information of any change.

[@emilyhope7468]

My doctor sent a prescription for Wegovy in with a prior authorization mentioning how it would help reduce cardiovascular disease. It was denied. 😢 I'm on Medicare though so hoping you have better luck. I have heard that the insurance companies probably won't even look at adding it to their formularies until 2025. My doctor, who is a bariatric physician, told me she is meeting with her drug rep from Novo Nordisk and will get clarification as to if you already have to have an existing heart problem, which I don't. I have high cholesterol.

[@joinfridays]

No approvals for this new indication yet here at Fridays.

[@nelic.2521]

I would love to join Fridays, any estimate time on when you will be available to US territories if that is possibility?

[@Tracey-mt4oe]

I would like some info on compound Mounjaro. Is it just as good and reliable ?

[@paulras01]

My employer specifically added to the 2024 medical benefits that weight-loss drugs are not covered. Only covers weight-loss programs (like Weight-watchers). When I search for Zepbound on our pharmacy benefits, it flat out says "NOT COVERED". Should I even bother trying to get a PA submitted?

[@rocknawe7336]

Hi Countess! Thank you - great, relevant interview! Questions: I'm on medicare advantage (70+ y.o. woman); insulin resistant most of my life & obese; on Mounjaro, lost 23 lbs then was denied the medication after Eli Lilly's recent new ruling & gaining the weight back no matter what diet I try!. Two appeals denied. 1) Can Join Fridays do compounding with FDA, NON-research grade Semaglutide and Tirzepatide (which I've heard would then be affordable, safe options)? 2) I'm wondering if Fridays could even help me or would it just be a waste of time & money?

[@emilyhope7468]

I'm in the same boat you're in. Medicare. I've been denied three times. Somehow they've got to get someone persuasive to speak with these insurance companies with concrete info on effective these drugs are for the disease called OBESITY. This guy the countess spoke with is very well versed/spoken. I wish someone like him and Oprah would go before Congress or the Senate and plead for us! Oprah has first hand knowledge and would be a great spokesperson.

[@lizabaradona6397]

How can Fridays help patients who have an insurance that does not cover weight loss medication?

[@gaye-leapleiman7593]

You look beautiful and pink is your color. Friday's seems like a great company and I am thankful for my Primary Care provider that started me on this journey and continues to support me at every turn. I have been on MJ since Jan 2023. My A1C numbers are great as is my weight.

[@nancyj4918]

wondering what pharmacy you use and also how you respond when doctors warn us not to use a compound?

[@TrudyJ]

Great interview! So if your employer does not have weight loss medications added to your insurance plan, PAs and appeals won’t work, correct? (Referring to Zepbound)

[@vickyintc]

I have zepbound coverage but Humana denied bc Medicare does not cover obesity so they go by Medicare's rules. 😢

[@tracimcdonough7947]

Can you get this on medicare and Medicaid if you live in Minnesota even though your got turned down but start it one month and I have all the symptoms of prediabetic and heart disease. Do you guys still prescribe it? Can I get it through my insurance through you guys or do you pay for it through you guys? How does your program work?

[@annahoover5296]

Hi Elizabeth

[@kathyreep4638]

What about Medicare people

[@kathyreep4638]

Can you get wegovy from Canada cheaper