Navigating the Prescription Process for GLP-1 Medications

Which medications are approved for weight loss?

The two GLP-1 medications that are FDA-approved specifically for weight loss are Wegovy, a weekly injectable, and Saxenda, a daily injectable.

Zepbound is a dual-action (GLP-1/GIP) weekly injectable that is also FDA-approved for weight loss.

Does a GLP-1 medication align with my goals, values and plans for the future?

This is the first question to ask yourself. A GLP-1 medication is not a “quick fix,” or even a temporary fix. These medications are intended to be lifelong, and to be used in addition to a healthful lifestyle. Meaning, once you lose the weight, you should continue taking your therapeutic dose for the rest of your life.

Why? The data are clear: patients who stop taking their GLP-1 after weight loss regain about two-thirds of the weight they lost. Here’s a study that highlights this finding:https://pubmed.ncbi.nlm.nih.gov/35441470/

Am I a candidate?

Wegovy, Saxenda and Zepbound are approved for weight loss in the following individuals:

• Adults with an initial BMI of ≥30, defined as “obesity”
• Adults with an initial BMI of ≥27, defined as “overweight,” with at least one weight-related comorbid condition

Weight-related comorbid conditions include high blood pressure, cardiovascular disease (such as coronary artery disease, heart attack or heart failure), high cholesterol, obstructive sleep apnea, type 2 diabetes, fatty liver, GERD/acid reflux, osteoarthritis, urinary incontinence, etc.

Source: UpToDate

If you would like to know your BMI, you can calculate it here: 

https://www.mdcalc.com/calc/29/body-mass-index-bmi-body-surface-area-bsa

GLP-1s are not for you if:

• You are pregnant
• You have a personal or family history of medullary thyroid carcinoma (MTC)
• You have multiple endocrine neoplasia syndrome type 2
  
  

For a comprehensive overview of the risks and benefits of these medications, see the links below, or talk with your provider:

• Wegovy: https://medlineplus.gov/druginfo/meds/a618008.html
• Saxenda: https://medlineplus.gov/druginfo/meds/a611003.html
• Zepbound: https://medlineplus.gov/druginfo/meds/a622044.html
  

What if I need a prior authorization?

This is a document submitted by your provider for your insurance company to determine whether they think a treatment is necessary before agreeing to cover it.

You can call your insurance company directly to find out if you will need a prior authorization for the medication you were prescribed. To help your provider complete the necessary questions on your form, have these answers ready:

• What is your current height and weight?
• Have you tried any diets or weight loss programs in the past? Insurance companies typically require at least six months of participation in a weight management program that focuses on lifestyle before agreeing to cover weight loss medications.
• Have you tried any other medications in the past for weight loss? If so, for how long? Did you have any side effects with these medications? Did they help you lose weight?
• Do you have any other chronic conditions? Examples include: diabetes, high blood pressure, high cholesterol, etc.
  
  

If your prior authorization is denied, your provider can appeal the decision on your behalf, although this may not change the outcome. While constructing an appeal, review the reason for denial and your health plan’s summary of benefits to ensure your treatment isn’t explicitly excluded. Gather any supporting documents that would be helpful to send along with your appeal and give them to your provider.

What if my pharmacy doesn’t have my prescription in stock?

In the not-too-distant past, there was a shortage of GLP-1 medications. Many pharmacies couldn’t get the medications in stock, translating to patients being unable to obtain their medications and often going weeks without it. If this happens to you, try calling different locations of your pharmacy chain. Oftentimes, you will find your medication in stock at another location and it is relatively effortless to get your prescriptions transferred there.

If you are interested in learning more about metabolic health and weight loss, please consult us at Dignity Weight Center! We would be honored to meet you, and we take most insurances!

If you are interested in learning more about metabolic health and weight loss, please consult us at Dignity Weight Center. We would be honored to meet you, and we accept most insurances.

https://www.dignityweightcenter.com/book-online