WEIGHT LOSS MEDICATIONS: FAQs
Many of our patients are asking whether they can or should take ‘the new medications’ they are hearing about to help with weight loss. We’d like to address some of the issues surrounding these medications. The two biggest obstacles are SUPPLY SHORTAGE and LACK OF INSURANCE COVERAGE.
Q: What are the medications we are referring to?
A: Two ‘new’ medications which are FDA approved for weight loss are WEGOVY (generic name = semaglutide) and ZEPBOUND (generic name = tirzepatide).
Q: I’d like to start taking one of these medications; can you send a prescription to my pharmacy please?
A: There is currently a shortage of WEGOVY and the company who produces it does not anticipate supplying more of this medication to the United States until sometime in 2024. ZEPBOUND is not covered by insurance without strict rules and lengthy trials of other weight loss medications (which are often also not covered by insurance).
Q: I’ve heard these medications are the same as OZEMPIC and MOUNJARO. Could you give me a prescription for one of those instead?
A: While it is true that OZEMPIC (semaglutide) is the same drug as WEGOVY, and MOUNJARO (tirzepatide) is the same drug as ZEPBOUND, both OZEMPIC and MOUNJARO are only approved for use and covered by insurance for individuals who have been diagnosed with Type II Diabetes. A diagnosis of pre-diabetes or borderline diabetes does not qualify for insurance to cover OZEMPIC or MOUNJARO.
Q: I’d like to purchase one of these medications without my insurance. How much do they cost?
A: The starting doses of WEGOVY cannot be purchased at this time because there is none to be had in the United States until sometime in 2024. ZEPBOUND and MOUNJARO average retail price is approximately $1,300.00 PER MONTH. OZEMPIC is approximately $878.00 PER MONTH.
Q: My pharmacy said I can get one of these medications as long as my provider does a ‘prior authorization.’ Would you do a prior authorization for me please?
A: Regardless of what your pharmacy tells you and regardless of what a customer service agent at your health insurance company tells you, unless you have Type II Diabetes, we cannot do a prior authorization for OZEMPIC or MOUNJARO. You cannot get OZEMPIC covered by insurance, even if you’ve been using WEGOVY prior to WEGOVY’s short supply. ZEPBOUND has very strict rules regarding prior authorization, which do not apply to most people.
We recognize that weight loss is a struggle for many, and despite working REALLY hard at it, weight loss can be elusive. The providers at Evergreen want nothing more than to support you. Unfortunately, when it comes to prescribing WEGOVY, OZEMPIC, ZEPBOUND and MOUNJARO, the obstacles are beyond our control.
The bottom line: if you do not have Type II Diabetes, your provider will not be prescribing the aforementioned medications and will not be completing prior authorizations for the foreseeable future. We look forward to the day when this will not be the case.