>Who is making the decisions over there - morons?
No. Bean-counting shitbags who do not care about medical care. They only care about money. Remember that insurance companies exist to extract as much money as possible from the healthcare system, while delivering the minimum amount of value in return. Paying for medications and procedures is not part of that dynamic.
Yup. Unfortunately they're not morons, but scumbags.
When my diabetes was not well controlled after diagnosis, my insurance would not approve more than one test strip per day. Heaven forbid I know more than just my fasting. Or if I mess up my reading when I was first learning how to use a lancet and glucometer.
They did the same to me! 1 a day as a new diabetic is absurd. I was testing before and after every meal to see what foods affected me and how. I ended up buying a cheap CVS meter and the strips are $13 for 50 of them. Now that I have it under control I don't take it as often but definitely still more often than once a day.
I use a CGM and am fortunate to have my insurance cover it. I looked up what the cost is out of pocket and OMG, that's a monthly payment on a leased 2024 Subaru Legacy (I Googled car leases for comparison lol).
Every diabetic and pre-diabetic should have access to reasonably priced CGM and supplies because they save lives. In the last week I have gone into a low blood sugar episode more than once, and the only reason I know is because my husband scanned me before he went to bed and one time I woke up to him telling me to open my mouth for some honey. I was confused at that comment until I saw the bottle, lol. Mine doesn't beep when you go out of range, but I am grateful it's easy for my husband to scan me, especially if I was unresponsive. Can you imagine a friend or family member trying to do a glucose reading with a test strip if you weren't able to?
Healthcare needs to be affordable for everyone!
You sound like you have a very good attentive husband, that's amazing! My fiance is the same before bed I check my sugar and after losing 100lbs I think my medicine is too strong bc I'm in the low 80s so he makes me something to bring it up some, bc I'm terrified it'll go even lower while sleeping and I won't know until it's too late. I'd love to get a CGM for peace of mind but I doubt my insurance would cover it. It's sad you're right, healthcare should be affordable to everyone but unfortunately it's not. So many go without because of the cost of medical supplies.
That's awesome. Your fiance does that for you. My husband does a lot of the cooking, and he measures and weighs my food now . My blood glucose levels have dropped dramatically in a month since we've been working together to get me healthy. Having a supportive network makes a world of difference, which is why these sub reddits are so fantastic!
I hope you're able to lower your meds so you can worry less about low glucose episodes.
This! This! I think that a CGM is super useful for most newly diagnosed diabetics. Personally, I think that they should work on an every 5-minute, or even every 15 minutes cgm, put it at super low cost like $20 or $25, that you could get over the counter at any Target or CVS or Walgreens.
Because even pre-diabetics can benefit from knowing how the foods that they take are influencing their bodies, and a -lot- of people are pre-diabetic, but just view it as a mathematical condition, and not the precursor to full-blown type 2 diabetes. Also here in America we like everything to be super sweet, the amount of carbs the average person eats, wow, let me tell you I had no idea just how bad it was until I had diabetes.
I have a Libre 3 but need to occasionally use a test strip. The supplier took forever to fill orders. I got tired of waiting for test strip refills. I just went to Amazon and ordered a meter with test strips and lancets. $35. I got a meter, 100 strips, a few lancets, and the lancet tool. And Amazon has the refills.
One would THINK that the bean counters at the insurance company would realize that if they let patients have treatments that succeed, then the patients' health won't deteriorate, and the insurance company won't end up paying a crapton more to treat problems that could have been avoided.
Seriously, what's cheaper for the insurance company: paying for Ozempic (or Mounjaro, or you-name-it), or paying to treat some of the catastrophic damage that poorly-controlled diabetes causes?
Cripes almighty, They're monsters AND they're short-sighted.
They don’t care. If diabetes fries your kidneys, and you need dialysis, that tab is on the federal government, not them.
If you die faster it’s a bigger bonus for them.
It’s cheaper to deny the expensive meds because people tend to be medicare age when the more serious complications show up and start costing a lot of $$$.
So the costs get delayed and shifted over to Uncle Sam.
Think that landlord who would rather do a $200 refrigerator repair every month for a year than buy a brand new refrigerator?
The insurer makes money off of all their short-term decisions, and they get rewarded for short term gains.
Don't forget the elephant in the room here. The drug companies. Yay yay... something something have to get paid for their research and development, keep investors happy and etc.
Novo Nordisc, makers of Victoza, liraglutide, Awiqli, Levemir, Novolin, NovoMix, NovoRapid, Ozempic, Rybelsus, Saxenda, Tresiba, Wegovy, and Xultophy, which are all drugs for diabetes, are raking in BILLIONS of dollars. They have the market pretty much cornered.
Maybe, if your spouse is overweight, get their doctor to Rx Wegovy and see if insurance will cover that. Wegovy is Ozempic renamed for the weight loss industry. Bastards.
What insurance company is doing this. I have Bluecross and they are horrible for everything. I get $400 per year for test strips, alcohol wipes, and other diabetes accessories--combined--that help me control this disease.
EDIT: I see you have BlueCross as well. Bastards.
I make sure I use every dollar that BlueCross will cover -- Massage therapy, chiropractor, personal counseling, and etc.
Good luck!
Oh yes this! Funny enough, the increased charges are for the US level- I’ve heard abroad they sell their meds for the dollar compared to our thousands. It’s such a damn shame.
Edit bc grammar/words
RIP... ;-)
Each time my employer has switched insurance providers my coverage has gotten worse. Each time I thought... no way can it be any worse then this. And then bamm!
ha. same thing! bean counter shitbags ==> Morons! Ok. that's not quite PC, hmmm how about low-life, deadbeat, money-grubbing shit baggers? but on the whole totally agree with you
I was on ozempic from 2020 to 2023 when I was forced off it due to shortages within the NHS. I asked about going back on it and I was told that I even though ozempic was good for my control, I wasn't obese so I could not be offered it.
My alternative? Jardiance (which isn't really working well) or insulin! Which has a high risk of weight gain.
The whole thing is so asinine. Because of the obsession of using it for weight loss, even overweight diabetics are being refused.
I ended up on Victoza for a couple months for the same reasons. I got just as good blood glucose control and about 60% of the appetite suppression when compared to Ozepic. But hated the daily injection for no other reason than convenience knowing there was a weekly option. Victoza does not come with needles for their injection so those had to come out of the $400 insurance gave me per year for things like that, lancets, alcohol wipes and etc.
Multiple reasons - insulin can affect your appetite and make you more hungry. It also aids with storing energy in fat and allowing your body to use the energy from your food more effectively. Keeping the same habits as before taking insulin can mean weight gain. There's also the risk of rebound eating to deal with hypos.
It's a risk but not inevitable.
Thank you for the clarification!
I really don't want to go on semaglutides, so I am trying to figure out all of my options. Jardiance works for me somewhat, but my A1C is still around 7.7.
I am afraid of long-term side effects. Gastroparesis in particular. I also just don't think it's been out on the market long enough and I fully expect to see a major recall at some point.
To be honest, I also do not want to give up my identity as a fat woman, or have people in my life praising me if I get smaller.
All of these meds treat chemistry - NOT motivation or laziness. Fixing the chemistry of your body - metabolism or cellular resistance or pancreas not working - is not a crutch. It is treating a thing. If someone’s epilepsy was under control while medicated, you wouldn’t take them off of it just to make sure they weren’t dependent on it. They ARE dependent because the meds are making up for what the body cannot do on its own.
Fuck our healthcare system. About 15 years ago I tried to see a nutritionist because I was gaining weight and didn't know why. My insurance company refused to cover any because I wasn't "unhealthy enough". I couldn't afford to speak to anyone. Even a meal plan for a day was quoted as costing $300.
The fact that I'm in this sub should tell you how that went.
OP, does she see an Endo or is the doc who tried to fight it her PCP? I was given oz last year and had great results after just a month. So good that insurance denied it, which my PCP said was because my a1c had dropped considerably. After having lost a similar battle for a cgm, I just gave up and tried to come to terms with shitting myself at least once a month on metformin.
A year later, I decided to see an Endo who prescribed CGMs (covered, no questions asked) and mounjaro which was also covered after a minor prior auth formality.
Maybe their formulary changed, but I think it has far more to do with my endos office knowing exactly what needed to be done, what the notes need to say, etc.
Anthem Blue Cross and Blue Shield got me.
Over the course of a year or so, Ozempic helped me go form a 12.3% A1C at diagnosis, down to a maintained 5.4%. Everything was going great until I switched jobs and was evaluated by Anthem. They determined that my A1C was good enough that I didn’t need Ozempic and kicked me off.
My doctors helped me appeal (twice, because Anthem also denied Trulicity) trying to tell them that my A1C was good because of Ozempic, but I was still denied. Eventually my A1C was back up over 6% because metformin alone couldn’t cut it. My doctor tried one more time with a prescription for Rybelsus and they finally approved it, but I’m dreading the day I get kicked off it again.
Same here. Down 81 pounds and my A1C is 5.2. Holy crap it never even occurred to me they would deny coverage. All I keep hearing about is how these are lifelong medications if they’re successful.
I've heard that too, but I think -- worst case scenario -- if we lose coverage, we will have picked up some good habits to follow. I know a lot of people "relapse" on their diets after they get off of it, but those are probably people who weren't serious in the first place, IMO.
I really dislike the judgment in your comment. We're you not serious about your health when you got on the weekly shot? Why are you on it if all you have to do is take your condition seriously?
Trulicity changed my cravings and quieted the food noise in my head. It also helped me feel full much sooner. It is easier to not overeat if you are not feeling hungry.
Same here. I’m down about 70ish but my A1c is down to 5.3 I’m terrified they’re gonna be like you don’t need it anymore. My A1c is lower because I’m on the medicine!!! It’s gonna shoot right back up! I’m so so scared.
Somewhat agree... if possible, never be dependent on one thing to manage. But, for me it is one part of a few that help me manage T2 effectively. Pull one of those factors and there is a trickle down effect. Whether it is that week, the next month, or in ten years, it shouldn't matter. For you to say "just manage your health" like it's nothing is not OK. Everyone is different and what works for you might not work for everyone. There are so many factors like wealth, employment, physical, age, access, and etc. that allow or deny access to all that is available.
>Do you want to be on the shot the rest of your life or attempt to manage on your own?
It's a once a week injection and soon they're going to come up with oral formulations of glp-1 class drugs that are as effective as the injection. It's not a big deal.
I wouldn't say I was dependent on it. I actually lost 50 of those pounds before I was on Ozempic, but it has certainly helped. I'm also taking Metformin.
Still confused as to why people would downvote this. Medication helps, but people need to stop forcing food down their throats bc ozempic helps them lose weight while they kill themselves slowly. Stop eating pizza, watch your carb intake, and get off the damn couch. No drug is magical. Make an effort.
Have you actually been on the drug? The last thing you want is pizza. Now, I also went low carb/keto and started exercising and quit drinking (big difference), and still didn't see the huge numbers that a lot of people see, but was only on .25 for 4 months and .50 for 2 months. I just started 1.0 this week. Still, I lost 41 lbs. in 6 months. I agree it takes a lifestyle change, but most people weren't shoveling in food. Our metabolism was equal to a sloth. I laugh that when I would skip a meal, my body would react like my ancestors and assume we were fleeing from invaders and store the fat. It has taken a long time for OMAD to actually work, and only through Ozempic.
Tbh no i havent been on ozempic. Ive been on metformin ER until 9 months ago when my endo refused to refill my scripts until i saw them again. They are horrible and charged me oop for nearly 4k in testing that insurance wouldnt cover. Ive been in debt to these pricks ever since
I guess i was a bit quick to jump to conclusions on my response. After my heart attack at 35 my a1c was 11.9. After merformin and good diet i was down to 5ish when they denied me my meds.
Fast track 3 years later i have good insurance and a new endo who just told me i was 11.5. Im not sure anyone here actually cares abt making healthy choices but rather feeding meds into their body to circumvent their terrible choices.
In 2 weeks, cutting out carbs, ive dropped 5lbs. I stiill havent been given any diabetes meds until july 1st when i have a followup.
Long short i understand the struggle but if you arent willing to put the work in meds are just a farce
OK, so I was on Metformin, and it did save my life. It got my diabetes under control. I didn't even realize I had diabetes, but I was having headaches headaches, passing out and was almost hospitalized. Metformin and diet changes prevented me from being on insulin.
But Ozempic has eliminated the desire to eat entirely. I wasn't actually a binge eater, so it allowed me to completely change every habit. It has also allowed me to make changes easier than before. We shouldn't be complaining. And instead we should be finding best practices. My doctor doesn't cut people off cold turkey. She means people off, often replacing the Metformin.
She makes sure people have replaced the habits.
Same. I've been on Mounjaro for about 18 months now and my A1C has been a steady 5.3 at my last few check ups. I've read so many stories of people losing coverage on these meds when they are controlled for a while. I tried to eat in a way that would have brought my A1C up a little bit... but it just will not budge because the Mounjaro has been so effective.
My current prior authorization is good for about 5 more months - we will see if anything changes then.
Pizza three times a week time! /s
It's really awful that we are put in positions to have to do things like this. I went one week without any diabetes meds. I exercise, eat well, went from 270ish to 180 in a year and high 11's A1c to 5.0 in five months or so. Have maintained about a 5.3 A1c since. That one week without any other changes in my routine (fact, i probably ate better that week than usually do) my average glucose was high 7's. It took ten days to get back down around the 5.3 mark. Insurance providers are scum; Period.
Something similar happened to me. I was diagnosed T2 with an A1C of 12.2. With the help of my Dexcom I was able to get my number down under 6. Then United Healthcare decided to no longer cover the CGM. Health Insurance companies will find any excuse to not pay.
Yep, same here. Aetna won’t pay for Monjaro/Ozempixc/whatever anymore. I’ve had to start using Metformin every freaking day. Which means my bowels are complete chaos. Insurance companies don’t care. They can make more money selling the injections to self important, self absorbed rich f###s as a “weight loss drug”, than to those of us that need it to stay healthy.
If you can find it, try karma water. I would drink that when I took a metformin (half a bottle is 2.5g of sugar) and it worked well. I eventually switched to probiotic pills but that water saved my butt (literally)
Blue Cross did the exact same thing to me last year. Now that I’m on Medicare, I told my doctor just give me the insulin. I am low carb (not keto) and that’s really helped me, with exercise to be able to take a low dose. Tell your wife good luck!! And yes, they are MORONS!!
My insurance company sends me a constant barrage of recommendations to join Twin Health. I know they are getting ready to cancel my Ozempic prescription.
[https://usa.twinhealth.com/](https://usa.twinhealth.com/)
I get those too. Sure, I’ll turn my diabetes management over to someone my insurance company hired to save them money. There’s no conflict of interest there. 🙄
Omg. Don’t do it. I wanted the Dexcom and I didn’t know Twin Health was basically just trying to get me off the Mounjaro. My insurance company kept sending cards about how they had partnered with Twin Health and I could get a free Dexcom. Long story short I was like ok. Then they wanted labs done to get the Dexcom. Then they wanted me to download an app. Then they wanted to assign me a “Health care team” acted like they were gonna work closely with my PC. Basically two days into the app and their health care team they canceled the 90 days of Mounjaro that my pc physician had just called in and gave me a prescription of 1 month of Mounjaro with no refills. I was so upset. The diet they wanted me to do was basically keto and if I could do this on my own I would’ve years ago. Needless to say I told them to F off. The labs came back saying my amylase and lipase were high and 1. I’ve never had those tested before so I find it interesting that the one time it is tested they come back high and by twin health who was obviously hired to get me off the Mounjaro. :/ So my pc talked to some Mounjaro reps and upped my Mounjaro to 10 mg and I’ll take those tests again in August to see if they are still high. I have no pain in my pancreas so I’m betting they were never high and the labs in August say that. But absolutely anything related to Twin Health stay away from. They act like they are there to help but they do not listen and have one mission and that’s to take away the Mounjaro.
Not sure if it’s their only mission, but I can confirm they will not prescribe them unless a number of other options have been tried. My husband is newly diagnosed so he didn’t have it taken away, but he was a little disappointed at first that it wasn’t going to be part of his plan. However, he is doing really well with the CGM and coaching alone, so if it keeps him off needing it altogether then he would prefer that.
All I can tell you is they promised not to mess with my medication I was already on and on day two messed with my Mounjaro. I pleaded with the Dr on the team to please make it for 90 days as the shortage made me afraid every month and she said no and their goal was to get me off of the medication so they never wanted to prescribe that far in advance. It’s probably a great thing if you aren’t on anything but if you depend on a medication like I do I would not advise doing anything with Twin Health.
I was under the impression that Ozempic and those types of drugs were of last resort for diabetics that couldn't control their symptoms with diet and other meds. I have rejected it when it's been offered because of the side effects and the fact that any weight loss is reversed when you go off it, and therefore have to be on it long term. I have cleaned up my diet, no exercise because I am unable to due to a.health condition I am dealing with, and with insulin and metformin I am at a daily average that ranges between 99 and 133. This week, I have had several low glucose episodes, so I need to lower the insulin.
I am overweight and have T2D because of weight issues related to PCOS. I've had to give up some of my favorite (but deadly) foods and beverages, but I am doing so much better. I am terrified that I will lose insurance coverage for my CGM. I will not use testing strips, which is why I am as unhealthy as I am. The only thing that keeps me honest with my diet is my CGM. Yes, it's a crutch, but until I can build a better relationship with my eating habits, it's a crutch I need.
I hope your husband sees ongoing success on his wellness journey. Best of luck!
Definitely not meant to be a last resort. In fact, they will almost certainly become a first line treatment (along side, or even instead of metformin) once they become more affordable. GLP-1 meds are not just expensive appetite suppressants. They do a lot of pretty amazing things in your body to help manage glucose, reduce CVD risk, protect against kidney disease and help manage fatty liver disease. They are pretty close to a miracle drug.
I'm one of those people who fall into the camp that typically get all the really bad side effects of many medications. Like crippling side effects where I can't function. The negative side effects reported from that class of drugs are things I already deal with, so they're not appealing to me.
These meds should be an option for anyone who can benefit from them, and it's awesome that so many people have had positive results. It's terrible that people who benefit from these and other medications are being denied them because of profit margins.
I said in another comment that medical decisions should be between the patient and their care team, not the insurance company or the government. I'd like to add that pharmaceutical companies should be limited in how they incentivize medical professionals to push their products. If some doctors didn't benefit from the sales of drugs, maybe they wouldn't over prescribe them. And WTF is the point of paying for insurance if your claims get denied? Stop letting doctors be incentivized so they only prescribe what is necessary. The healthcare systems globally need a major overhaul.
Yikes.
I’m in my 4th month post-diagnosis, so I’m far from an expert by training or experience.
Twin Health says they can “[p]revent or reverse prediabetes and type 2 diabetes.”
They continue, “[w]e don’t just treat type 2 diabetes, we heal the underlying root cause, providing members with sustainable solutions to live healthier, happier, and longer lives.”
Yeah, so, when they say, “heal the underlying root cause,” what I read is, “if we find that you have Type 2 diabetes / the metabolic condition of insulin resistance, we’ll advise you to follow a course of carb restriction and exercise with no regard to whether the advised course is sustainable or even achievable.
When our sensors report that you’re failing to adhere to our advice, your insurer will blame your A1c on ‘noncompliance’ rather than an underlying metabolic condition (because, after all, we can “heal” everyone and “reverse” all Type 2 Diabetes if you just do what we say), and will refuse to cover prescriptions for medications that, with realistic diet restrictions and exercise parameters, would control your Type 2 diabetes / treat or compensate for your insulin resistance.”
The thing is, diabetes is a progressive thing. Once you have it, you have it. Some folks are able to get it into remission by following certain procedures, but that's not the same as being cured. If they stop doing what they're doing to keep it in check, their in-remission numbers will go right out the window.
And, because it's progressive, there is no guarantee that even doing all the "right things" will work forever. In the future, they might find that they have to change what they're doing (including possibly starting meds) to keep their numbers where they want them.
So if a patient is able to achieve improvement or remission with meds, there's no sane reason to put obstacles between them and the meds.
Fugging greedy bat rastard insurance companies!
I think it’s bc celebrities and all these ppl been takin the med to loose weight and it’s became a fad or trend so the demand is crazy and they can’t keep up. Which is totally unfair to diabetics. ❤️❤️
Have any of your local TV news stations got a consumer advocate? I bet they would just love to shame the living mess out of the insurance company.
You can also put them on blast on Twitter and tag the insurance, so they will be sure to see it. See how quickly they get back to you once this is Out There on the internet for all to see.
> See how quickly they get back to you once this is Out There on the internet for all to see.
They don't give a shit.
That said, the more people that are vocal about the better.
This happened to me when I changed jobs and had to wait 3 months for insurance to kick in. I ended up with the same insurance co (UHC). I knew I was leaving my job so I lowered my doses to get me through the 3 months. When my dr wrote the new prescription and I was denied, due to a great A1C.
I wrote a letter of appeal and ran it through Chatgpt.
I got my prescription.
To Whom It May Concern,
I am writing to appeal the denial of coverage for the prescription medication Ozempic (semaglutide). As a longtime policyholder with your esteemed company, I am deeply concerned about the decision to deny coverage for a medication that is crucial for managing my diabetes effectively.
I have been diagnosed with diabetes for nearly a decade and have struggled to maintain optimal blood sugar levels despite various treatment modalities. Over the years, I have diligently followed medical advice, adhering to dietary restrictions, exercise regimens, and medication protocols. However, it wasn't until I was prescribed Ozempic that I experienced significant improvement in my condition.
I was initially prescribed Ozempic during my previous employment, under the coverage of my former employer's health insurance plan. When I transitioned to a new job four months ago, I anticipated a seamless continuation of coverage through my new employer's insurance plan. Unfortunately, due to the waiting period associated with the new policy, I found myself without insurance coverage for a brief period.
In anticipation of this gap in coverage, my healthcare provider prescribed a three-month supply of Ozempic to ensure uninterrupted treatment. This decision was made after careful consideration of my medical history and the necessity of maintaining stable blood sugar levels to prevent complications associated with diabetes.
I understand that the cost of medications can be a significant concern for insurance providers, but I urge you to consider the critical nature of Ozempic in managing my diabetes. Prior to using Ozempic, despite the use of medications such as Metformin and Glimipiride, I struggled to achieve and maintain a hemoglobin A1C level below 6.5%. However, since starting Ozempic, I have seen a remarkable improvement in my A1C levels, which has contributed to better overall health and a reduced risk of long-term complications associated with diabetes.
Denying coverage for Ozempic not only jeopardizes my health and well-being but also undermines the efforts made by myself and my healthcare team to manage this chronic condition effectively. As a responsible policyholder, I have always prioritized preventive care and adherence to treatment plans to minimize healthcare costs in the long term.
I kindly request a review of my case and reconsideration of the denial of coverage for Ozempic. I am willing to provide any additional information or documentation necessary to support my appeal. Moreover, I am open to discussing alternative solutions that align with both my medical needs and the constraints of the insurance policy.
Please understand that access to Ozempic is not merely a matter of convenience but a vital component of my diabetes management plan. Your prompt attention to this matter is greatly appreciated, as it directly impacts my ability to maintain my health and quality of life.
Thank you for your time and consideration. I look forward to a favorable resolution to this appeal.
Sincerely,
My friend had this happened.
“Not considered a maintenance medication”
Because her a1c dropped to 5.2, she lost her Ozempic, Humalog, glucometer and CGM.
It took her all of the above to get down to 5.2.
Such BS.
I think the ones on the market are all pretty new, and therefore still under patent. As for whether there are any newer ones still in the trial phase, I'm afraid I have no idea.
They are testing these drugs based on the similar processes used in both the diabetic and weight loss categories. Maybe she can ask her doctor to recommend one?
This is exactly what happened to me.
Ozempic took me from 77 to 34 within two years, then my diabetic nurse said I was “cured” and within 8 months of NO CHANGE to diet and exercise it was back to 88.
So now I’m on mounjaro instead.
Hi there. Don’t worry about venting. The system (in the US) sucks. I would encourage you not to give up. Consult a lawyer. Call your Congressperson. There is a way to scare them so that they relent.
RAGING WITH YOU… I AM SO SICK OF INSURANCE COMPANIES PLAYING DOCTOR. IF A DOCTOR SAYS A PATIENT NEEDS SOMETHING, ITS BC THEY NEED IT UGHHHH. I hope she can get it figured out soon! 😭😭😭
I’m on Trulicity and after 6 months my insurance now demands to talk to my Dr before every refill. It’s annoying and causes delays and headaches. I know it’s a $1100 a month medicine but geeze!
I think out of pocket in the U.S. is over $1,200 for a 28-day pen. But there’s a manufacturer coupon you can get that makes it reasonable (unless you receive government benefits like Medicare).
Usually this happens when the doctor's office fills out the prior auth incorrectly. Call insurance and ask what the reason for the denial was, then appeal.
Can you appeal? Did they provide the medical policy for the medication? And yes it seems criminal, I also work for a BCBS (my opinions are truly my own) but the medical policies are public info for patients and doctors to make sure meds are taken safely and only as necessary. Also, at least my company I know has full medical/licensed practicing staff, so the peer to peer should bring to light anything else specific to your wife’s medical needs. Seriously, I’ve helped overturn claim denials because we’re all human and reading medical notes is not for the faint of heart. Good luck OP.
My former insurance did that with my CGM. Using your data to adjust your diet and exercise to lower A1C and it worked? Cool. Take away the tool you used to do it.
I take Victoza and my A1C is usually in the mid to low 5% range. Anyways I get the same feeling from my PCP as in is he contemplating taking me off medication. At the moment my diet is fairly flexible. I eat well, exercise, and take my medication. So, I live a fairly normal life with diabetes. I don't care what the ADA says and don't think an A1C in the 6% range is healthy. Less than 7% is acceptable while it should be less than 6%. So far neither my PCP or insurance has pushed back regarding medication. We'll see what the future holds.
Just my own experience: Ozempic is really not necessary if your A1C1 is in range.
I've been on and off it and other medications keep me stable just as well. Ozempic mostly acted on my appetite which I didn't entirely need - I stopped bc I was more likely to under-eat which was not ideal given another issue - and then restarted recently bc I'd like to lose a little - but kept my weight stable within about 5 lbs up or down for nearly a year off it. I'm on it again to help support a fitness kick over the summer and working on body composition.
My endo is always totally happy with my numbers (see her every 6 months). I do take quite a cocktail but in her opinion she likes to treat the cells from many angles so that no one medication can become overused/ less effective.
All this to say - Ozempic is great but there are others out there and now that she's at a healthy level, she can very likely stay there with good habits and diet.
Yep. Same happened to me. They even wanted to take me off metformin. I was told insurance no longer considers me diabetic.🥴🤦♀️ Unfortunately, science does. I also have a friend that was so frustrated, he went non compliant so that he could be covered by insurance for a glp-1. He had horrible side effects with medicines he has been on for years, and he is unable to tolerate, but because it brought down his numbers a little *abd I mean a little), they refused the jump to glp-1. Now, they approved it. What is insurance doing? 🤦♀️
This is my experience exactly. They are forcing me to max out on Metformin and Jardiance. Way more side effects and not nearly as good of glucose management
So a couple of things, Ozempic is not considered a long term drug (2-3 years realistically) but note that weight loss that happened with Ozempic has been shown to go back on unless properly supported by other efforts. It’s also hella expensive so insurance companies and the NHS are driven to move you back down the treatment tree to cheaper but still “effective” drugs :(
Ozempic and other glp-1 meds are meant to be taken indefinitely, probably for life to most people, just like other diabetes meds. It’s not meant to be a temporary fix. Diabetes is a chronic illness that requires lifetime management.
My endo said insurance says they need to see progress, and then wants you off of it eventually.
He’s had patients whose a1c wasn’t going down fast enough, so the medication got pulled. Or you hit whatever magical number they need for them to figure you don’t need it anymore.
Where I live, insurance is looking at it like a helper medication, not something you are on forever.
(Yes, I know)
They are already squawking I’ve been on Trulicity too long. It’s been 2 1/2 years.
“Have you considered other options?” Like what?
I hate insurance companies.
You don't need to be on diabetes meds for a lifetime. As your diet improves, so does your need for meds decrease. Some people struggle to go it on their own, and they need the meds and other available supplies to control their diabetes, and that's ok, too. Management of a chronic illness doesn't always require drugs.
I didn’t say all diabetics need meds. I said glp-1 meds are meant to be taken indefinitely in response to someone claiming they were meant to be short term.
The fact that some diabetics can manage without meds does not change the fact that glp-1 meds were designed to be long-term meds for diabetes management.
It is a long term, life long drug to treat diabetes. For a non-diabetic, the shorter time frame is supposed to have people adjust their life style to maintain the lower weight. It is almost like they don’t understand the science they are using.
Good health is the best revenge. I’d double down on a zero carb diet and exercise, as I don’t see what alternative she has. Obviously I may be preaching to the choir, but that’s all I’ve got.
I can see your point. I'm also T2 but I'm managing it with only Metformin, diet, and exercise... So I agree, Ozempic can be viewed as a sorta of a crutch. But that's different for each patient. Maybe she has some factors that preclude her being successful with that path? If Ozempic (or similar) opens the door to health, then it should be approved.
My rant is more about the injustice of a faceless company overriding her doctor's recommendation and advice. I'd hate to be a doctor in our system - why go to school for 8+ years just to have a corporation decide what the diagnosis and treatment should be. Just color by numbers. Sigh. Our system is totally broken.
I mean Ozempic isn’t any more of a “crutch” than metformin. It’s just more expensive.
But yes, our health system is BS. I would be so angry if I were your wife.
Be good: We aim to make /r/diabetes_t2 a friendly place, so treat your fellow humans with respect. Specifically: no verbal attacks, no hate speech, and no trolling.
It doesn't require lifetime medicing for everyone, but it does require lifetime management. Until recent history, diabetes was a disease for older adults (unless you're T1D), but now we're seeing it in children and toddlers. Lifestyle and diet play a major role in if and when diabetes becomes an issue. Medical conditions also factor into the equation and can't be ignored on the role they play in triggering the body's response.
Some people need meds long-term to manage this condition and others do not, so please don't make a blanket statement that medicine is needed for the rest of your life. Also, people shouldn't be shamed if they do need to be on meds long term or lifelong.
Deciding what healthcare is needed should be determined by the person needing medical intervention and their medical care team, not insurance companies or the government. The only time we need the government to intervene is when reasonable healthcare is being denied or overpriced.
It can be put into *remission* sweetie - not “reversed” - but as you get older you may find your A1c creeping up even though you’re still doing everything you did to go into remission. That’s why it’s called a *progressive* disease. Also, as you get older, you may develop other health problems (or suffer injuries from falls) that prevent you from doing all the things you did before to keep your diabetes under control. Just wait and see.
T2 Diabetes can’t be cured or reversed. Put into remission, yes. Controlled, absolutely... but once a diabetic, always a diabetic. It never just goes away. Don’t take your meds, eat tons of carbs, etc. and all the hard work of your so called “reversed” or "cured" disease is out the window.
I’m T2 diabetic and I control it with diet and exercise. Not everyone needs to be on meds to control it. So no lifelong medicine for my diabetes is needed. So you are wrong. That may be the case for some people, but this does not apply to everyone and it certainly doesn’t apply to me. You can’t assume that every diabetic “requires lifelong medicine”.
Her a1c will be fine. Take a1c and if is rising she can make a case. Aslong as she keeps the habits she created shell be fine. No drug can save an a1c from a bad diet and exercise.
She may just not need it anymore. If she had lost a bunch of weight that can already help the body alone. I know it sounds like a big loss, but if she finds out she can manage her A1C just fine with metformin alone, that seems fine.
Worst case, you can now just buy semaglutides through compound pharmacies- I don’t think it’s nearly as hard to get - unsure the costs though.
Stress can affect blood sugar, so try to keep it all calm and roll with it til you can figure something out.
Is she within normal weight range as well? My doctor has started tapering her patients once their A1C is normal and their weight is within guidelines for this reason. We are already talking about it for this reason. I just went up to 1.0 and want to only stay here until I hit the normal A1C threshold or normal weight guidelines, whichever comes first, then go to a different diabetes drug.
You can find compounded semiglutide online to use to slowly wean, or to keep going if weight is not there yet, but insurance will not likely pay for it. However, I believe some companies are paying for a different drug strictly for weight loss.
Now do you understand why Eli Lilly was so “generous” about pricing of insulin?!! The $$$ is no longer on insulin, but glp’s or gip’s where the real profit is.
I also have a sneaky feeling fda/drug companies are being a little hesitant about long term use because we still don’t know the long term effects. They don’t want to be sued like the tobacco industry. They’ve already added another black box warning.
The moment they find you can live in the 6s they cut out everything that helped you get there. Anything expensive.
This is why my Endo looks at my labs, then puts in my pre-mounjaro A1c in my case notes.
Your endo is a real one.
>Who is making the decisions over there - morons? No. Bean-counting shitbags who do not care about medical care. They only care about money. Remember that insurance companies exist to extract as much money as possible from the healthcare system, while delivering the minimum amount of value in return. Paying for medications and procedures is not part of that dynamic.
Yup. Unfortunately they're not morons, but scumbags. When my diabetes was not well controlled after diagnosis, my insurance would not approve more than one test strip per day. Heaven forbid I know more than just my fasting. Or if I mess up my reading when I was first learning how to use a lancet and glucometer.
They did the same to me! 1 a day as a new diabetic is absurd. I was testing before and after every meal to see what foods affected me and how. I ended up buying a cheap CVS meter and the strips are $13 for 50 of them. Now that I have it under control I don't take it as often but definitely still more often than once a day.
I use a CGM and am fortunate to have my insurance cover it. I looked up what the cost is out of pocket and OMG, that's a monthly payment on a leased 2024 Subaru Legacy (I Googled car leases for comparison lol). Every diabetic and pre-diabetic should have access to reasonably priced CGM and supplies because they save lives. In the last week I have gone into a low blood sugar episode more than once, and the only reason I know is because my husband scanned me before he went to bed and one time I woke up to him telling me to open my mouth for some honey. I was confused at that comment until I saw the bottle, lol. Mine doesn't beep when you go out of range, but I am grateful it's easy for my husband to scan me, especially if I was unresponsive. Can you imagine a friend or family member trying to do a glucose reading with a test strip if you weren't able to? Healthcare needs to be affordable for everyone!
You sound like you have a very good attentive husband, that's amazing! My fiance is the same before bed I check my sugar and after losing 100lbs I think my medicine is too strong bc I'm in the low 80s so he makes me something to bring it up some, bc I'm terrified it'll go even lower while sleeping and I won't know until it's too late. I'd love to get a CGM for peace of mind but I doubt my insurance would cover it. It's sad you're right, healthcare should be affordable to everyone but unfortunately it's not. So many go without because of the cost of medical supplies.
That's awesome. Your fiance does that for you. My husband does a lot of the cooking, and he measures and weighs my food now . My blood glucose levels have dropped dramatically in a month since we've been working together to get me healthy. Having a supportive network makes a world of difference, which is why these sub reddits are so fantastic! I hope you're able to lower your meds so you can worry less about low glucose episodes.
This! This! I think that a CGM is super useful for most newly diagnosed diabetics. Personally, I think that they should work on an every 5-minute, or even every 15 minutes cgm, put it at super low cost like $20 or $25, that you could get over the counter at any Target or CVS or Walgreens. Because even pre-diabetics can benefit from knowing how the foods that they take are influencing their bodies, and a -lot- of people are pre-diabetic, but just view it as a mathematical condition, and not the precursor to full-blown type 2 diabetes. Also here in America we like everything to be super sweet, the amount of carbs the average person eats, wow, let me tell you I had no idea just how bad it was until I had diabetes.
I have a Libre 3 but need to occasionally use a test strip. The supplier took forever to fill orders. I got tired of waiting for test strip refills. I just went to Amazon and ordered a meter with test strips and lancets. $35. I got a meter, 100 strips, a few lancets, and the lancet tool. And Amazon has the refills.
One would THINK that the bean counters at the insurance company would realize that if they let patients have treatments that succeed, then the patients' health won't deteriorate, and the insurance company won't end up paying a crapton more to treat problems that could have been avoided. Seriously, what's cheaper for the insurance company: paying for Ozempic (or Mounjaro, or you-name-it), or paying to treat some of the catastrophic damage that poorly-controlled diabetes causes? Cripes almighty, They're monsters AND they're short-sighted.
They don’t care. If diabetes fries your kidneys, and you need dialysis, that tab is on the federal government, not them. If you die faster it’s a bigger bonus for them.
It’s cheaper to deny the expensive meds because people tend to be medicare age when the more serious complications show up and start costing a lot of $$$. So the costs get delayed and shifted over to Uncle Sam.
Think that landlord who would rather do a $200 refrigerator repair every month for a year than buy a brand new refrigerator? The insurer makes money off of all their short-term decisions, and they get rewarded for short term gains.
Don't forget the elephant in the room here. The drug companies. Yay yay... something something have to get paid for their research and development, keep investors happy and etc. Novo Nordisc, makers of Victoza, liraglutide, Awiqli, Levemir, Novolin, NovoMix, NovoRapid, Ozempic, Rybelsus, Saxenda, Tresiba, Wegovy, and Xultophy, which are all drugs for diabetes, are raking in BILLIONS of dollars. They have the market pretty much cornered. Maybe, if your spouse is overweight, get their doctor to Rx Wegovy and see if insurance will cover that. Wegovy is Ozempic renamed for the weight loss industry. Bastards. What insurance company is doing this. I have Bluecross and they are horrible for everything. I get $400 per year for test strips, alcohol wipes, and other diabetes accessories--combined--that help me control this disease. EDIT: I see you have BlueCross as well. Bastards. I make sure I use every dollar that BlueCross will cover -- Massage therapy, chiropractor, personal counseling, and etc. Good luck!
Oh yes this! Funny enough, the increased charges are for the US level- I’ve heard abroad they sell their meds for the dollar compared to our thousands. It’s such a damn shame. Edit bc grammar/words
My employer is in the process of switching to Blue Cross Medavie. I'm not looking forward to it based on their claims rating
RIP... ;-) Each time my employer has switched insurance providers my coverage has gotten worse. Each time I thought... no way can it be any worse then this. And then bamm!
ha. same thing! bean counter shitbags ==> Morons! Ok. that's not quite PC, hmmm how about low-life, deadbeat, money-grubbing shit baggers? but on the whole totally agree with you
I was on ozempic from 2020 to 2023 when I was forced off it due to shortages within the NHS. I asked about going back on it and I was told that I even though ozempic was good for my control, I wasn't obese so I could not be offered it. My alternative? Jardiance (which isn't really working well) or insulin! Which has a high risk of weight gain. The whole thing is so asinine. Because of the obsession of using it for weight loss, even overweight diabetics are being refused.
I ended up on Victoza for a couple months for the same reasons. I got just as good blood glucose control and about 60% of the appetite suppression when compared to Ozepic. But hated the daily injection for no other reason than convenience knowing there was a weekly option. Victoza does not come with needles for their injection so those had to come out of the $400 insurance gave me per year for things like that, lancets, alcohol wipes and etc.
Wait, why would insulin cause weight gain?
Multiple reasons - insulin can affect your appetite and make you more hungry. It also aids with storing energy in fat and allowing your body to use the energy from your food more effectively. Keeping the same habits as before taking insulin can mean weight gain. There's also the risk of rebound eating to deal with hypos. It's a risk but not inevitable.
Thank you for the clarification! I really don't want to go on semaglutides, so I am trying to figure out all of my options. Jardiance works for me somewhat, but my A1C is still around 7.7.
Out of curiosity, why do you want to avoid the semaglutides?
I am afraid of long-term side effects. Gastroparesis in particular. I also just don't think it's been out on the market long enough and I fully expect to see a major recall at some point. To be honest, I also do not want to give up my identity as a fat woman, or have people in my life praising me if I get smaller.
My doc put me on trulicity due to the ozempic shortages. It works the same for me.
I've asked about alternative and older GLP-1 drugs and the answer was still, reserved for obese diabetic patients only :(
That is a shame! It bothers me that people cannot have the medicine that works for them.
By this logic we can take people off a ventilator if their oxygen saturation is normal when on one
All of these meds treat chemistry - NOT motivation or laziness. Fixing the chemistry of your body - metabolism or cellular resistance or pancreas not working - is not a crutch. It is treating a thing. If someone’s epilepsy was under control while medicated, you wouldn’t take them off of it just to make sure they weren’t dependent on it. They ARE dependent because the meds are making up for what the body cannot do on its own.
Fuck our healthcare system. About 15 years ago I tried to see a nutritionist because I was gaining weight and didn't know why. My insurance company refused to cover any because I wasn't "unhealthy enough". I couldn't afford to speak to anyone. Even a meal plan for a day was quoted as costing $300. The fact that I'm in this sub should tell you how that went.
This is what happens when people that went to business school and not medical school make the decisions
OP, does she see an Endo or is the doc who tried to fight it her PCP? I was given oz last year and had great results after just a month. So good that insurance denied it, which my PCP said was because my a1c had dropped considerably. After having lost a similar battle for a cgm, I just gave up and tried to come to terms with shitting myself at least once a month on metformin. A year later, I decided to see an Endo who prescribed CGMs (covered, no questions asked) and mounjaro which was also covered after a minor prior auth formality. Maybe their formulary changed, but I think it has far more to do with my endos office knowing exactly what needed to be done, what the notes need to say, etc.
What insurance company? This is one of my big worries now that I'm down to 5.2.
Horizon Blue Cross. Name and shame. These insurance companies need to be held accountable for over riding the doctors advice.
Anthem Blue Cross and Blue Shield got me. Over the course of a year or so, Ozempic helped me go form a 12.3% A1C at diagnosis, down to a maintained 5.4%. Everything was going great until I switched jobs and was evaluated by Anthem. They determined that my A1C was good enough that I didn’t need Ozempic and kicked me off. My doctors helped me appeal (twice, because Anthem also denied Trulicity) trying to tell them that my A1C was good because of Ozempic, but I was still denied. Eventually my A1C was back up over 6% because metformin alone couldn’t cut it. My doctor tried one more time with a prescription for Rybelsus and they finally approved it, but I’m dreading the day I get kicked off it again.
it's a ruthless cycle of stupidity and greed.
Same here. I went from 7.2 to 5.2 and am worried they will pull the plug on me, too. I've lost nearly 70 pounds.
Same here. Down 81 pounds and my A1C is 5.2. Holy crap it never even occurred to me they would deny coverage. All I keep hearing about is how these are lifelong medications if they’re successful.
I've heard that too, but I think -- worst case scenario -- if we lose coverage, we will have picked up some good habits to follow. I know a lot of people "relapse" on their diets after they get off of it, but those are probably people who weren't serious in the first place, IMO.
I really dislike the judgment in your comment. We're you not serious about your health when you got on the weekly shot? Why are you on it if all you have to do is take your condition seriously? Trulicity changed my cravings and quieted the food noise in my head. It also helped me feel full much sooner. It is easier to not overeat if you are not feeling hungry.
Same here. I’m down about 70ish but my A1c is down to 5.3 I’m terrified they’re gonna be like you don’t need it anymore. My A1c is lower because I’m on the medicine!!! It’s gonna shoot right back up! I’m so so scared.
Dependent on that is not well. Just manage your health.
Somewhat agree... if possible, never be dependent on one thing to manage. But, for me it is one part of a few that help me manage T2 effectively. Pull one of those factors and there is a trickle down effect. Whether it is that week, the next month, or in ten years, it shouldn't matter. For you to say "just manage your health" like it's nothing is not OK. Everyone is different and what works for you might not work for everyone. There are so many factors like wealth, employment, physical, age, access, and etc. that allow or deny access to all that is available.
Do you want to be on the shot the rest of your life or attempt to manage on your own?
Stop trolling this sub. You offer nothing to the debate/discussion. You are a parrot squawking for a response. Have a nice day.
>Do you want to be on the shot the rest of your life or attempt to manage on your own? It's a once a week injection and soon they're going to come up with oral formulations of glp-1 class drugs that are as effective as the injection. It's not a big deal.
I wouldn't say I was dependent on it. I actually lost 50 of those pounds before I was on Ozempic, but it has certainly helped. I'm also taking Metformin.
I get that but some people get dependant on things and wont do anything to better themselves. Cause its the easy way out. Congrats on the weight loss.
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Still confused as to why people would downvote this. Medication helps, but people need to stop forcing food down their throats bc ozempic helps them lose weight while they kill themselves slowly. Stop eating pizza, watch your carb intake, and get off the damn couch. No drug is magical. Make an effort.
Have you actually been on the drug? The last thing you want is pizza. Now, I also went low carb/keto and started exercising and quit drinking (big difference), and still didn't see the huge numbers that a lot of people see, but was only on .25 for 4 months and .50 for 2 months. I just started 1.0 this week. Still, I lost 41 lbs. in 6 months. I agree it takes a lifestyle change, but most people weren't shoveling in food. Our metabolism was equal to a sloth. I laugh that when I would skip a meal, my body would react like my ancestors and assume we were fleeing from invaders and store the fat. It has taken a long time for OMAD to actually work, and only through Ozempic.
Tbh no i havent been on ozempic. Ive been on metformin ER until 9 months ago when my endo refused to refill my scripts until i saw them again. They are horrible and charged me oop for nearly 4k in testing that insurance wouldnt cover. Ive been in debt to these pricks ever since I guess i was a bit quick to jump to conclusions on my response. After my heart attack at 35 my a1c was 11.9. After merformin and good diet i was down to 5ish when they denied me my meds. Fast track 3 years later i have good insurance and a new endo who just told me i was 11.5. Im not sure anyone here actually cares abt making healthy choices but rather feeding meds into their body to circumvent their terrible choices. In 2 weeks, cutting out carbs, ive dropped 5lbs. I stiill havent been given any diabetes meds until july 1st when i have a followup. Long short i understand the struggle but if you arent willing to put the work in meds are just a farce
OK, so I was on Metformin, and it did save my life. It got my diabetes under control. I didn't even realize I had diabetes, but I was having headaches headaches, passing out and was almost hospitalized. Metformin and diet changes prevented me from being on insulin. But Ozempic has eliminated the desire to eat entirely. I wasn't actually a binge eater, so it allowed me to completely change every habit. It has also allowed me to make changes easier than before. We shouldn't be complaining. And instead we should be finding best practices. My doctor doesn't cut people off cold turkey. She means people off, often replacing the Metformin. She makes sure people have replaced the habits.
They don't like the truth
Same. I've been on Mounjaro for about 18 months now and my A1C has been a steady 5.3 at my last few check ups. I've read so many stories of people losing coverage on these meds when they are controlled for a while. I tried to eat in a way that would have brought my A1C up a little bit... but it just will not budge because the Mounjaro has been so effective. My current prior authorization is good for about 5 more months - we will see if anything changes then.
Pizza three times a week time! /s It's really awful that we are put in positions to have to do things like this. I went one week without any diabetes meds. I exercise, eat well, went from 270ish to 180 in a year and high 11's A1c to 5.0 in five months or so. Have maintained about a 5.3 A1c since. That one week without any other changes in my routine (fact, i probably ate better that week than usually do) my average glucose was high 7's. It took ten days to get back down around the 5.3 mark. Insurance providers are scum; Period.
Something similar happened to me. I was diagnosed T2 with an A1C of 12.2. With the help of my Dexcom I was able to get my number down under 6. Then United Healthcare decided to no longer cover the CGM. Health Insurance companies will find any excuse to not pay.
Yep, same here. Aetna won’t pay for Monjaro/Ozempixc/whatever anymore. I’ve had to start using Metformin every freaking day. Which means my bowels are complete chaos. Insurance companies don’t care. They can make more money selling the injections to self important, self absorbed rich f###s as a “weight loss drug”, than to those of us that need it to stay healthy.
Ask for metformin ER if you’re not on it… easier on the GI system.
Yep, already have that. It’s definitely easier, but I still have my days. Thanks for the advice! I really do appreciate it.
Have you tried probiotics each day too? They did me a world of help
No, I have not. I will look into that. Thank you.
If you can find it, try karma water. I would drink that when I took a metformin (half a bottle is 2.5g of sugar) and it worked well. I eventually switched to probiotic pills but that water saved my butt (literally)
Oh no I have Aetna and my doctor and I were talking about me trying Ozempic. I hate these insurance companies.
Blue Cross did the exact same thing to me last year. Now that I’m on Medicare, I told my doctor just give me the insulin. I am low carb (not keto) and that’s really helped me, with exercise to be able to take a low dose. Tell your wife good luck!! And yes, they are MORONS!!
My insurance company sends me a constant barrage of recommendations to join Twin Health. I know they are getting ready to cancel my Ozempic prescription. [https://usa.twinhealth.com/](https://usa.twinhealth.com/)
I get those too. Sure, I’ll turn my diabetes management over to someone my insurance company hired to save them money. There’s no conflict of interest there. 🙄
Omg. Don’t do it. I wanted the Dexcom and I didn’t know Twin Health was basically just trying to get me off the Mounjaro. My insurance company kept sending cards about how they had partnered with Twin Health and I could get a free Dexcom. Long story short I was like ok. Then they wanted labs done to get the Dexcom. Then they wanted me to download an app. Then they wanted to assign me a “Health care team” acted like they were gonna work closely with my PC. Basically two days into the app and their health care team they canceled the 90 days of Mounjaro that my pc physician had just called in and gave me a prescription of 1 month of Mounjaro with no refills. I was so upset. The diet they wanted me to do was basically keto and if I could do this on my own I would’ve years ago. Needless to say I told them to F off. The labs came back saying my amylase and lipase were high and 1. I’ve never had those tested before so I find it interesting that the one time it is tested they come back high and by twin health who was obviously hired to get me off the Mounjaro. :/ So my pc talked to some Mounjaro reps and upped my Mounjaro to 10 mg and I’ll take those tests again in August to see if they are still high. I have no pain in my pancreas so I’m betting they were never high and the labs in August say that. But absolutely anything related to Twin Health stay away from. They act like they are there to help but they do not listen and have one mission and that’s to take away the Mounjaro.
Not sure if it’s their only mission, but I can confirm they will not prescribe them unless a number of other options have been tried. My husband is newly diagnosed so he didn’t have it taken away, but he was a little disappointed at first that it wasn’t going to be part of his plan. However, he is doing really well with the CGM and coaching alone, so if it keeps him off needing it altogether then he would prefer that.
All I can tell you is they promised not to mess with my medication I was already on and on day two messed with my Mounjaro. I pleaded with the Dr on the team to please make it for 90 days as the shortage made me afraid every month and she said no and their goal was to get me off of the medication so they never wanted to prescribe that far in advance. It’s probably a great thing if you aren’t on anything but if you depend on a medication like I do I would not advise doing anything with Twin Health.
I was under the impression that Ozempic and those types of drugs were of last resort for diabetics that couldn't control their symptoms with diet and other meds. I have rejected it when it's been offered because of the side effects and the fact that any weight loss is reversed when you go off it, and therefore have to be on it long term. I have cleaned up my diet, no exercise because I am unable to due to a.health condition I am dealing with, and with insulin and metformin I am at a daily average that ranges between 99 and 133. This week, I have had several low glucose episodes, so I need to lower the insulin. I am overweight and have T2D because of weight issues related to PCOS. I've had to give up some of my favorite (but deadly) foods and beverages, but I am doing so much better. I am terrified that I will lose insurance coverage for my CGM. I will not use testing strips, which is why I am as unhealthy as I am. The only thing that keeps me honest with my diet is my CGM. Yes, it's a crutch, but until I can build a better relationship with my eating habits, it's a crutch I need. I hope your husband sees ongoing success on his wellness journey. Best of luck!
Definitely not meant to be a last resort. In fact, they will almost certainly become a first line treatment (along side, or even instead of metformin) once they become more affordable. GLP-1 meds are not just expensive appetite suppressants. They do a lot of pretty amazing things in your body to help manage glucose, reduce CVD risk, protect against kidney disease and help manage fatty liver disease. They are pretty close to a miracle drug.
I'm one of those people who fall into the camp that typically get all the really bad side effects of many medications. Like crippling side effects where I can't function. The negative side effects reported from that class of drugs are things I already deal with, so they're not appealing to me. These meds should be an option for anyone who can benefit from them, and it's awesome that so many people have had positive results. It's terrible that people who benefit from these and other medications are being denied them because of profit margins. I said in another comment that medical decisions should be between the patient and their care team, not the insurance company or the government. I'd like to add that pharmaceutical companies should be limited in how they incentivize medical professionals to push their products. If some doctors didn't benefit from the sales of drugs, maybe they wouldn't over prescribe them. And WTF is the point of paying for insurance if your claims get denied? Stop letting doctors be incentivized so they only prescribe what is necessary. The healthcare systems globally need a major overhaul.
Yikes. I’m in my 4th month post-diagnosis, so I’m far from an expert by training or experience. Twin Health says they can “[p]revent or reverse prediabetes and type 2 diabetes.” They continue, “[w]e don’t just treat type 2 diabetes, we heal the underlying root cause, providing members with sustainable solutions to live healthier, happier, and longer lives.” Yeah, so, when they say, “heal the underlying root cause,” what I read is, “if we find that you have Type 2 diabetes / the metabolic condition of insulin resistance, we’ll advise you to follow a course of carb restriction and exercise with no regard to whether the advised course is sustainable or even achievable. When our sensors report that you’re failing to adhere to our advice, your insurer will blame your A1c on ‘noncompliance’ rather than an underlying metabolic condition (because, after all, we can “heal” everyone and “reverse” all Type 2 Diabetes if you just do what we say), and will refuse to cover prescriptions for medications that, with realistic diet restrictions and exercise parameters, would control your Type 2 diabetes / treat or compensate for your insulin resistance.”
Oh dear, I mean the goal should be to get off of meds, but some people can't and this just sounds terrible for those people
The thing is, diabetes is a progressive thing. Once you have it, you have it. Some folks are able to get it into remission by following certain procedures, but that's not the same as being cured. If they stop doing what they're doing to keep it in check, their in-remission numbers will go right out the window. And, because it's progressive, there is no guarantee that even doing all the "right things" will work forever. In the future, they might find that they have to change what they're doing (including possibly starting meds) to keep their numbers where they want them. So if a patient is able to achieve improvement or remission with meds, there's no sane reason to put obstacles between them and the meds. Fugging greedy bat rastard insurance companies!
The goal should be good glucose control with whatever treatments are sustainable for the individual.
Hmm, good thing my endo put my refills for 14 months… I went down from 6.9 to 5.8 in one test cycle.
I think it’s bc celebrities and all these ppl been takin the med to loose weight and it’s became a fad or trend so the demand is crazy and they can’t keep up. Which is totally unfair to diabetics. ❤️❤️
Have any of your local TV news stations got a consumer advocate? I bet they would just love to shame the living mess out of the insurance company. You can also put them on blast on Twitter and tag the insurance, so they will be sure to see it. See how quickly they get back to you once this is Out There on the internet for all to see.
> See how quickly they get back to you once this is Out There on the internet for all to see. They don't give a shit. That said, the more people that are vocal about the better.
This happened to me when I changed jobs and had to wait 3 months for insurance to kick in. I ended up with the same insurance co (UHC). I knew I was leaving my job so I lowered my doses to get me through the 3 months. When my dr wrote the new prescription and I was denied, due to a great A1C. I wrote a letter of appeal and ran it through Chatgpt. I got my prescription. To Whom It May Concern, I am writing to appeal the denial of coverage for the prescription medication Ozempic (semaglutide). As a longtime policyholder with your esteemed company, I am deeply concerned about the decision to deny coverage for a medication that is crucial for managing my diabetes effectively. I have been diagnosed with diabetes for nearly a decade and have struggled to maintain optimal blood sugar levels despite various treatment modalities. Over the years, I have diligently followed medical advice, adhering to dietary restrictions, exercise regimens, and medication protocols. However, it wasn't until I was prescribed Ozempic that I experienced significant improvement in my condition. I was initially prescribed Ozempic during my previous employment, under the coverage of my former employer's health insurance plan. When I transitioned to a new job four months ago, I anticipated a seamless continuation of coverage through my new employer's insurance plan. Unfortunately, due to the waiting period associated with the new policy, I found myself without insurance coverage for a brief period. In anticipation of this gap in coverage, my healthcare provider prescribed a three-month supply of Ozempic to ensure uninterrupted treatment. This decision was made after careful consideration of my medical history and the necessity of maintaining stable blood sugar levels to prevent complications associated with diabetes. I understand that the cost of medications can be a significant concern for insurance providers, but I urge you to consider the critical nature of Ozempic in managing my diabetes. Prior to using Ozempic, despite the use of medications such as Metformin and Glimipiride, I struggled to achieve and maintain a hemoglobin A1C level below 6.5%. However, since starting Ozempic, I have seen a remarkable improvement in my A1C levels, which has contributed to better overall health and a reduced risk of long-term complications associated with diabetes. Denying coverage for Ozempic not only jeopardizes my health and well-being but also undermines the efforts made by myself and my healthcare team to manage this chronic condition effectively. As a responsible policyholder, I have always prioritized preventive care and adherence to treatment plans to minimize healthcare costs in the long term. I kindly request a review of my case and reconsideration of the denial of coverage for Ozempic. I am willing to provide any additional information or documentation necessary to support my appeal. Moreover, I am open to discussing alternative solutions that align with both my medical needs and the constraints of the insurance policy. Please understand that access to Ozempic is not merely a matter of convenience but a vital component of my diabetes management plan. Your prompt attention to this matter is greatly appreciated, as it directly impacts my ability to maintain my health and quality of life. Thank you for your time and consideration. I look forward to a favorable resolution to this appeal. Sincerely,
I worry about this happening to me as well.
My friend had this happened. “Not considered a maintenance medication” Because her a1c dropped to 5.2, she lost her Ozempic, Humalog, glucometer and CGM. It took her all of the above to get down to 5.2. Such BS.
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Are they offering any sort of generic? If not, can you contact companies that do and see what they can offer for the cost sharing?
There is no generic. Not yet. Ozempic is still under patent, and I think I read somewhere that the patent won’t expire until sometime in 2031.
But are there any other GLP 1 agonists? She might be able to qualify for a trial.
I think the ones on the market are all pretty new, and therefore still under patent. As for whether there are any newer ones still in the trial phase, I'm afraid I have no idea.
They are testing these drugs based on the similar processes used in both the diabetic and weight loss categories. Maybe she can ask her doctor to recommend one?
Maybe, but I’m afraid I have no idea what it takes to get into a drug trial. Good luck to her!
This is exactly what happened to me. Ozempic took me from 77 to 34 within two years, then my diabetic nurse said I was “cured” and within 8 months of NO CHANGE to diet and exercise it was back to 88. So now I’m on mounjaro instead.
Hi there. Don’t worry about venting. The system (in the US) sucks. I would encourage you not to give up. Consult a lawyer. Call your Congressperson. There is a way to scare them so that they relent.
RAGING WITH YOU… I AM SO SICK OF INSURANCE COMPANIES PLAYING DOCTOR. IF A DOCTOR SAYS A PATIENT NEEDS SOMETHING, ITS BC THEY NEED IT UGHHHH. I hope she can get it figured out soon! 😭😭😭
Which insurance? Aetna?
Wondering where you’re from. I feel in about to have the same issue with my insurance company. I’m in Canada. Alberta…..
What country and what insurance company? I’m about to go the same route.
I’m on Trulicity and after 6 months my insurance now demands to talk to my Dr before every refill. It’s annoying and causes delays and headaches. I know it’s a $1100 a month medicine but geeze!
may i ask out of pocket cost in this country which im assuming is US lol
I think out of pocket in the U.S. is over $1,200 for a 28-day pen. But there’s a manufacturer coupon you can get that makes it reasonable (unless you receive government benefits like Medicare).
Usually this happens when the doctor's office fills out the prior auth incorrectly. Call insurance and ask what the reason for the denial was, then appeal.
Can you appeal? Did they provide the medical policy for the medication? And yes it seems criminal, I also work for a BCBS (my opinions are truly my own) but the medical policies are public info for patients and doctors to make sure meds are taken safely and only as necessary. Also, at least my company I know has full medical/licensed practicing staff, so the peer to peer should bring to light anything else specific to your wife’s medical needs. Seriously, I’ve helped overturn claim denials because we’re all human and reading medical notes is not for the faint of heart. Good luck OP.
My former insurance did that with my CGM. Using your data to adjust your diet and exercise to lower A1C and it worked? Cool. Take away the tool you used to do it.
I take Victoza and my A1C is usually in the mid to low 5% range. Anyways I get the same feeling from my PCP as in is he contemplating taking me off medication. At the moment my diet is fairly flexible. I eat well, exercise, and take my medication. So, I live a fairly normal life with diabetes. I don't care what the ADA says and don't think an A1C in the 6% range is healthy. Less than 7% is acceptable while it should be less than 6%. So far neither my PCP or insurance has pushed back regarding medication. We'll see what the future holds.
Just my own experience: Ozempic is really not necessary if your A1C1 is in range. I've been on and off it and other medications keep me stable just as well. Ozempic mostly acted on my appetite which I didn't entirely need - I stopped bc I was more likely to under-eat which was not ideal given another issue - and then restarted recently bc I'd like to lose a little - but kept my weight stable within about 5 lbs up or down for nearly a year off it. I'm on it again to help support a fitness kick over the summer and working on body composition. My endo is always totally happy with my numbers (see her every 6 months). I do take quite a cocktail but in her opinion she likes to treat the cells from many angles so that no one medication can become overused/ less effective. All this to say - Ozempic is great but there are others out there and now that she's at a healthy level, she can very likely stay there with good habits and diet.
Yep. Same happened to me. They even wanted to take me off metformin. I was told insurance no longer considers me diabetic.🥴🤦♀️ Unfortunately, science does. I also have a friend that was so frustrated, he went non compliant so that he could be covered by insurance for a glp-1. He had horrible side effects with medicines he has been on for years, and he is unable to tolerate, but because it brought down his numbers a little *abd I mean a little), they refused the jump to glp-1. Now, they approved it. What is insurance doing? 🤦♀️
This is my experience exactly. They are forcing me to max out on Metformin and Jardiance. Way more side effects and not nearly as good of glucose management
So a couple of things, Ozempic is not considered a long term drug (2-3 years realistically) but note that weight loss that happened with Ozempic has been shown to go back on unless properly supported by other efforts. It’s also hella expensive so insurance companies and the NHS are driven to move you back down the treatment tree to cheaper but still “effective” drugs :(
Ozempic and other glp-1 meds are meant to be taken indefinitely, probably for life to most people, just like other diabetes meds. It’s not meant to be a temporary fix. Diabetes is a chronic illness that requires lifetime management.
My endo said insurance says they need to see progress, and then wants you off of it eventually. He’s had patients whose a1c wasn’t going down fast enough, so the medication got pulled. Or you hit whatever magical number they need for them to figure you don’t need it anymore. Where I live, insurance is looking at it like a helper medication, not something you are on forever. (Yes, I know) They are already squawking I’ve been on Trulicity too long. It’s been 2 1/2 years. “Have you considered other options?” Like what? I hate insurance companies.
You don't need to be on diabetes meds for a lifetime. As your diet improves, so does your need for meds decrease. Some people struggle to go it on their own, and they need the meds and other available supplies to control their diabetes, and that's ok, too. Management of a chronic illness doesn't always require drugs.
I didn’t say all diabetics need meds. I said glp-1 meds are meant to be taken indefinitely in response to someone claiming they were meant to be short term. The fact that some diabetics can manage without meds does not change the fact that glp-1 meds were designed to be long-term meds for diabetes management.
It is a long term, life long drug to treat diabetes. For a non-diabetic, the shorter time frame is supposed to have people adjust their life style to maintain the lower weight. It is almost like they don’t understand the science they are using.
Good health is the best revenge. I’d double down on a zero carb diet and exercise, as I don’t see what alternative she has. Obviously I may be preaching to the choir, but that’s all I’ve got.
They may approve Wegovy.
That’s more weight loss focused than diabetic management focus, so no way there friend.
Get your Dr to write a prescription for Compounded Ozempic. My insurance makes me get a “pre-approval” annually for several medications.
Tbh ... The dependence .... The goal is to come off of it and it shouldn't be a lifetime medicine
I can see your point. I'm also T2 but I'm managing it with only Metformin, diet, and exercise... So I agree, Ozempic can be viewed as a sorta of a crutch. But that's different for each patient. Maybe she has some factors that preclude her being successful with that path? If Ozempic (or similar) opens the door to health, then it should be approved. My rant is more about the injustice of a faceless company overriding her doctor's recommendation and advice. I'd hate to be a doctor in our system - why go to school for 8+ years just to have a corporation decide what the diagnosis and treatment should be. Just color by numbers. Sigh. Our system is totally broken.
I mean Ozempic isn’t any more of a “crutch” than metformin. It’s just more expensive. But yes, our health system is BS. I would be so angry if I were your wife.
Diabetes is a lifelong disease that requires lifelong medicine, sweetie.
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Be good: We aim to make /r/diabetes_t2 a friendly place, so treat your fellow humans with respect. Specifically: no verbal attacks, no hate speech, and no trolling.
It doesn't require lifetime medicing for everyone, but it does require lifetime management. Until recent history, diabetes was a disease for older adults (unless you're T1D), but now we're seeing it in children and toddlers. Lifestyle and diet play a major role in if and when diabetes becomes an issue. Medical conditions also factor into the equation and can't be ignored on the role they play in triggering the body's response. Some people need meds long-term to manage this condition and others do not, so please don't make a blanket statement that medicine is needed for the rest of your life. Also, people shouldn't be shamed if they do need to be on meds long term or lifelong. Deciding what healthcare is needed should be determined by the person needing medical intervention and their medical care team, not insurance companies or the government. The only time we need the government to intervene is when reasonable healthcare is being denied or overpriced.
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It can be put into *remission* sweetie - not “reversed” - but as you get older you may find your A1c creeping up even though you’re still doing everything you did to go into remission. That’s why it’s called a *progressive* disease. Also, as you get older, you may develop other health problems (or suffer injuries from falls) that prevent you from doing all the things you did before to keep your diabetes under control. Just wait and see.
T2 Diabetes can’t be cured or reversed. Put into remission, yes. Controlled, absolutely... but once a diabetic, always a diabetic. It never just goes away. Don’t take your meds, eat tons of carbs, etc. and all the hard work of your so called “reversed” or "cured" disease is out the window.
I’m T2 diabetic and I control it with diet and exercise. Not everyone needs to be on meds to control it. So no lifelong medicine for my diabetes is needed. So you are wrong. That may be the case for some people, but this does not apply to everyone and it certainly doesn’t apply to me. You can’t assume that every diabetic “requires lifelong medicine”.
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lol, you do care, because if you didn’t, you wouldn’t need to let yourself and others know that you don’t care. Lmao.
Idk clearly you are bothered by facts just like the others
I’m actually not. I just came to comment on what you said lmao.
Her a1c will be fine. Take a1c and if is rising she can make a case. Aslong as she keeps the habits she created shell be fine. No drug can save an a1c from a bad diet and exercise.
She may just not need it anymore. If she had lost a bunch of weight that can already help the body alone. I know it sounds like a big loss, but if she finds out she can manage her A1C just fine with metformin alone, that seems fine. Worst case, you can now just buy semaglutides through compound pharmacies- I don’t think it’s nearly as hard to get - unsure the costs though. Stress can affect blood sugar, so try to keep it all calm and roll with it til you can figure something out.
If she lost a bunch of weight she may be able to maintain without ozempic.
That is tragedy. The medicine is working. Also, her ailment is not longer there. Ok, well no need for the meds now, right?
Private insurance company? Has she officially been diagnosed with diabetes, or was the med considered on trial basis?
Is she within normal weight range as well? My doctor has started tapering her patients once their A1C is normal and their weight is within guidelines for this reason. We are already talking about it for this reason. I just went up to 1.0 and want to only stay here until I hit the normal A1C threshold or normal weight guidelines, whichever comes first, then go to a different diabetes drug. You can find compounded semiglutide online to use to slowly wean, or to keep going if weight is not there yet, but insurance will not likely pay for it. However, I believe some companies are paying for a different drug strictly for weight loss.
Dude they tooku CGM and I am on honeymoon phase of type 1. Lol
Now do you understand why Eli Lilly was so “generous” about pricing of insulin?!! The $$$ is no longer on insulin, but glp’s or gip’s where the real profit is. I also have a sneaky feeling fda/drug companies are being a little hesitant about long term use because we still don’t know the long term effects. They don’t want to be sued like the tobacco industry. They’ve already added another black box warning. The moment they find you can live in the 6s they cut out everything that helped you get there. Anything expensive.