by Richard Weil, M.Ed., CDE
Founder and Director
Transformation Weight Control

Congratulations on your decision to consider taking a weight loss medication, or as some people refer to them, anti-obesity medications. The GLP-1 receptor agonists approved for weight loss (Zepbound, Wegovy, and Saxenda), are the most successful weight loss medications we’ve ever seen. They are game-changers, and that’s not a term I’ve ever used to describe any weight loss medication.  These are the steps you take, in order, if you’re considering one of these medications. I’m going to stick to GLP-1’s in this blog, but don’t forget to discuss Qsymia, Contrave, Phentermine, alli, Xenical, and Plenity with your doctor too.

1. Call your insurance company and find out what weight loss meds they cover.

2. If your insurance is limited and will not cover the meds, or just a fraction of the cost, then search the manufacturer’s website (Lilly or Novo) to see what savings coupons or rebates, if any, they offer for which drug, and at what dose.

3. Then you go to Lilly Direct, a new program from Lilly, where they sell their proprietary drugs at a much reduced cost, the only difference is that the drug you order from Lilly Direct, say Zepbound, comes in single-dose vials with syringes in the two lowest doses 2.5mg, and 5.0mg only (maximum dose is 15.0 mg), and these two doses are self-pay ($395/month for 2.5 mg, and $549/month for 5.0mg). Syringes and vials means you have to draw up the proper dose of the medication from the vial with the syringe, and then inject with the syringe where you see the needle. Once your doctor wants to increase your dose above 5.0mg, you must switch to the pen device, and then you will need insurance prior authorization from your insurance company (no prior authorization is necessary for the 2.5 and 5.0mg vials). 

4. Keep in mind that people with diabetes drew up insulin from vials and injected themselves with syringes all the time for many, many decades, before insulin came in pens like the weight loss meds do now. So this is nothing new, and in fact, the Lilly Direct program uses syringes with needles that are just about, or exactly, the same size as insulin syringes. 

5. The most important thing to consider with Lilly Direct is that most likely you are going to need a higher dose than 5.0mg, in which case you’re going to be back dealing with your insurance company. Think about the 2.5 and 5.0mg dosages as maintenance doses once you lose the weight you want to lose on higher doses, and then you are ready to cut back the dose. For more information:  https://lillydirect.lilly.com/

6. Now that you know which medications your insurance will (or will not) cover, and what the costs will be, then you go to your doctor to discuss which drug you will take, with cost as a factor, if, as I said, the money is important to you, because you’ve done the background work. For most people, of course, money is an issue, and weight loss medications are expensive.

7. If you go to the doctor first, you’re going to end up having to  backtrack and do all this background work anyway, and now you have wasted time at the doctor’s office and had to pay for that visit, and then, of course, you’d have to go back to the doctor again. If you do the background work first, then you can present the best financial situation to guide the doctor in which drug he or she prescribes. It’s unfortunate that the meds are so expensive, and insurance companies are so stingy, and you have to do it this way if the money is important to you, but that’s the reality. Just know that pretty much everyone for whom money is an issue, which includes just about everyone, goes through exactly the same thing.

8. Now, if your insurance company will cover only one of the meds, then it’s easy, you just go with that one after discussing it with your doctor. If they will cover more than one (which is unlikely), then you go to your doctor to discuss which one to use.

9. To plug our program, consider joining our weight loss medication support group, where issues like these, and many, many others, are regularly discussed. We created this group to deal with all the weight loss medication issues; physiological, psychological, and practical, such as acquiring and paying for the meds.  To read more: https://transformationweightcontrol.com/12-week-weight-loss-medication-support-group/

And that, as they say in Yiddish, is the whole magilla!

© Rich Weil, M.Ed., CDE 2024 All Rights Reserved