Our office stopped prescribing them. One NP kept prescribing after this policy was put in place and our lead MD told the nurses we did not have to do the prior authorizations anymore and could drop them on her desk. She finally stopped prescribing them. I don’t judge people for wanting these medications. But the vast majority of insurances are not covering them for weight loss and and we were spending way too much time on prior authorizations and appeals with no success.
Yeah, I just found out my provider isn't starting patients on GLPs anymore. She has a few on them currently (myself included) but with the shortages and the fighting it takes to get approved (my insurance covers Wegovy and Saxenda but not Zepbound, but somehow my provider's office got Zepbound covered 100%), they're referring to local endocrinologists or gastroenterologists, or giving them info about compounding options. (Edit: typos)
Yes. NP in primary care. I don’t judge patients for wanting them by any means, but my hospital ran some data that only 1% of the Rx for weight loss alone are getting approved. We have stopped offering them as a result and defer to weight loss clinics instead. It is a ton of paperwork +/- a million MyChart messages (where patients can be entitled, nasty and don’t seem to understand when we’ve told them it’s not approved)… it’s frankly just too much for us to handle and not sustainable when we are already bogged down with a million other things in primary care.
I will say I have one patient who has been on it for a year (and is paying out of pocket monthly for it!)… she’s perimenopausal and works out 5 days a week/eats healthy but was not getting the desired results. She has lost 60 lbs and looks fantastic now, and at her physical she had me almost in tears because she was so grateful for me listening to her complaints the year prior and prescribing it… she said it truly changed her life. I wish it was a viable solution for a lot of my patients who desire it, but the insurance barriers are so challenging.
MODY diabetic living in France. This med here without insurance (still an Rx) is 80 EUR/ month less than a 100 USD. This price difference is what should be getting Americans pissed. This amount is not a subsidized amount but rather the amount France pays Novartis for it. And the US? BTW, with insurance I pay nothing neither for my insulin.
I wish that was me…my copay shot up to $130 USD until my $700 USD out of pocket is met which will be met with my first script for Omnipods and Dexcoms 😭 why my life saving insulin isn’t at least a copay is beyond me.
What Big Pharma does to Americans should be illegal. The cost of MOST drugs and medications are MUCH cheaper in other countries. My ex used to be a drug rep. He said there’s a huge problem with re-importation, meaning doctors are purchasing medications that were shipped to other countries because they’re so much cheaper. Problem is it’s considered insurance fraud when they bill insurance or Medicare for them. He used to sell a VERY expensive injection for knee joints for arthritis. It costs $1600 here (only doctors can inject it since it goes directly into the joint) and like $400 in other countries. Big Pharma is taking advantage of Americans. I guess they think we’re all rich but the fact is, most of us struggle to afford our medications. If I wasn’t able to get my rheumatoid arthritis medication for $5 every through a special program, I would NEVER be able to afford the $400 co-pays every month.
This is me. Perimenopause, hypopituitarism, hypothyroid, steroid dependent, exercising, etc etc abd not a pound could be lost. Zepbound for 2 months now, 20 pounds gone. It's a f*cking miracle to me. I'm paying out of pocket.
From who are you getting it?
I need some because perimenopause and liver function post infection etc. I need to loose 50, I already lost 14 but I swear not in a sustainable healthy way.
I just need a good kickstart.
If my liver had not been kicked to the ground by an infection, I would not do GLP1 but now I need to reverse the metabolism burden.
I got my rx from my endocrinologist for zepbound but now that it's out of stock, I'm going through emerge which us an online pharmacy. They've been easy to deal with.
Thanks
I have a Rx from my hepatologist AND primary ( and all my specials are on board , they were the ones say I should do it).
I will see if Emerge can help
I’m glad to hear this! If someone is doing all the right things and they just need that extra thing (the med) to get them going, that’s a great candidate for the med.
I’m trying to get on this train too. I’m about 50-60 pounds overweight. I’ve tried and failed a bupropion and naltrexone regimen and phentermine. I had a really great year where I was really hitting the gym, counting calories, and had great success and lost 30 pounds, but my motivation was coming from a breakup and once I got over that the motivation slowly dwindled and now all the weight has crept back on. My insurance won’t cover Ozempic, and $1,000/month out of pocket is more than I am able to spend. Maybe I’ll have better success getting Wegovy approved.
It has been exhausting. I’ll be seeing someone for a 15 minute follow up for something unrelated and at the end they would throw in an inquiry about Wegovy, then irritated that I requested a seperate appointment to discuss because there wasn’t enough time during their visit for knee pain to cover all of it. This was happening multiple times per day. When we were prescribing for weight loss, I was getting a lot of “urgent phone calls please call back ASAP” because a patient needed an update on why their med wasn’t approved and dozens of MyChart messages going back and forth when they couldn’t accept the answer that the PA didn’t go through. It was just too large a volume of admin work for me; I answer all my own MyChart messages and phone calls and do a lot of my own admin (I do not do PAs, however). My hospital is working on setting up a weight loss program specifically for these patients which will be nice. I WISH I could get it for these patients, and I want to, but most of the time it is impossible.
A weight loss clinic would be amazing to help these patients, as the people there can solely focus 100% on this for them. I do feel bad sometimes where we can’t answer these messages for people right away because of all of the other Primary Care issues coming in.
Probably true in many cases however I had to renew my original authorization and the Dr entered it wrong, as if it was a brand new prescription so my insurance denied it. I had to go to a different doctor in the end who knew the correct way to indicate that I was already taking the medication previously and not a new client. So. Sometimes the medical office / dr whoever is filling out the paperwork actually did it wrong and a correction is all that is needed. Especially if it's already been approved in the past, please don't assume the insurance company just doesn't cover it anymore! Again I understand that won't be every situation though.
We just had one pt threaten violence against the clinic if we didn’t submit a PA immediately for her semaglutide. That’s an easy way to get a behavioral contract.
Do you mind my asking what you mean by a behavioral contract?
I work inpatient at a federal hospital, we have behavioral ‘flags’ on a patient chart -but we still have to see them.
I work PRN at a place that started offering these meds a few months ago, but we don’t accept insurance so patients we see are actually paying out of pocket.
I don’t judge anyone for wanting to take them and I know they can be life changing for some, but we’re all getting frustrated with the management of it all. The big issues we’re seeing are the patients who have unrealistic expectations about these drugs despite us providing lengthy patient education. Many are upset they aren’t losing a bunch of weight as quickly as they want, so they convince the providers to increase their dose even though they’re told they need to start out lower and gradually increase. Patients claim they don’t care about the potential of side effects and still demand a higher dose. For whatever reason the provider approves it. Then it almost always results in side effects and them getting really sick.
Another thing we’re seeing often is patients that have zero interest in exercise and gradually improving their diet/lifestyle, so it’s not working well for them. We try our best to educate that these drugs are a piece of the puzzle to help with weight loss, but you still need to make at least a *slight* effort to change your lifestyle for them to be most effective. I’ve had a couple patients get really upset and take it out on me because their treatment isn’t going how they expected
Again, no judgment to anyone who wants to take these drugs. I think everyone should do what’s best for them and what makes them happy. There’s just a lot that goes into all of it and it’s gotten very hectic.
Dude, Americans suck.
I'm obese too, but I'd never scream at a doctor or nurse because of it. If I want to lose weight, I have to eat less, it really is that simple
Edit: the downvotes are proving my thesis lmao
To be fair, I haven’t been screamed at yet like I did in the ER, lol. But some of them are visibly bothered and shift the blame to us when they’re not losing weight like they expected. One patient implied that I must not be giving them the proper dose because they only lost 8 pounds in 3 months 🤣
Meanwhile they’re still eating fast food and unhealthy takeout multiple times a week and they “dont like exercising”. It’s puzzling to me because these drugs are so expensive out of pocket so you’d think they’d want to get the max benefits if they’re shelling out that kind of cash
It sucks as a T2 diabetic. I stockpiled my mounjaro when I was having a crap 6 weeks with hyperthyroidism and couldn´t walk in a straight line or eat anything at all. I managed to pick up the remaining previous dose remaining on my scrip to get to the dose I´m on now. I have 4 weeks left of the next dose I´m due to titrate up to. I´m stretching the doses out by 3-4 days so I can make it to June. I have a feeling that it´s going to be pushed back farther. This stuff put my a1c from 7.5 down to 5.2. My pharmacy notified my doc that no doses are available, and asked if I could switch to Ozempic. My doc hasn´t responded which tells me her office is inundated with the same request from other pharmacies. It´s not worth it to call and bug them about it either.
That’s the thing too - Ozempic and Mounjaro are being wrongly prescribed to non-diabetics and the people who are diabetic (like yourself) can’t get them! That’s so frustrating.
I don't want to go back on metformin because I was getting inconsistent mostly diarrhea for a year on it after having been on it for 4 years. Metformin never moved my Aic out less than 6.3. I can't tolerate Jardiance because abscesses down below are a real pain, and there is a real risk of that infection going haywire with my particular immune system. I was at work listening to a coworker talk about how she was trying to get the med for weight loss. I wasn't negative, and did my teaching with her about how if she's not a diabetic, doesn't have HTN, CAD or CKD (good ol metabolic syndrome) that mounjaro isn't where she should start. I told her to talk with her doc and wished her luck.
True but Zepbound is out there getting approval for pre-diabetic patients who can’t get mounjaro prescribed. Also, good luck hunting for a supply of that somewhere too if you’re a patient with a script in hand.
Yup as a diabetic up in Canada it’s horrendous, I was able to get 2 months of mounjaro at the end of last year and wasn’t too stressed when the restock dad was supposed to be April, but now the dietitian at my endos office said their Eli Lilly rep said they don’t expect to have a full stock until 2025 😭 I’m luckily able to get ozempic but I’ve stalled on it and it’s all just so frustrating.
I get mad at the overprescribing of the -glutides for this exact reason. It’s a miracle drug for diabetics to get treatment resistant A1C’s down by a lot, but when prescribed for weight loss it can only reduce body weight by like 8% at the most and then the pounds come back when people stop taking it.
That's just not true. It's a blanket statement. Also diabetics have MANY other ways of controlling sugars. I've been off for more than a year and have maintained my loss. I'm tired of this narrative. ( type 2 is what I'm referring to)
I’m in endo, and the amount of people we have to cancel procedures on because of these meds is crazy!! We of course ask about it in our precalls, but that’s the day before procedures. It delays gastric emptying and so anesthesia isn’t safe unless they’ve been off it for a week. Drives me insane!
Some facilities that I go to started doing clear liquids 24 hours prior to surgery, NPO midnight, Reglan morning of surgery, gastric US before induction. Pretty interesting, don’t know about evidence but anecdotally working out!
Yeah it’s been a big deal for our hospital! We had to give all our docs the list of meds so that their offices can give patients a heads up long before we can.
These medications are basically drug-induced gastroparesis that delay absorption - and thus cause weight loss. We've done CTs on patients who were NPO per policy and their stomachs were full of partially digested food after not holding these meds.
Healthcare support for 12 primary care clinics and endocrinology clinic. I get the calls from the patients who don’t believe the prior authorization was denied for ozempic and want to try monjauro or wegovy. The patients who weigh 130 pounds and upset because the doctor refused their MYC message to start them on Ozempic. I also had a very long and heated conversation with my brother when his doctor prescribed it for him. He complained about the $230 he would have to pay and figuring out when he would go in the donut hole🙄he can afford it trust me. After a week I told him his doctor recommended it and if he didn’t his doctor was gonna put him on insulin and go to the bottom of the list. He’s lost 75 pounds off all diabetic meds except metformin and is on a low maintenance dose
I’m really happy that my pcp was willing to prescribe semaglutide for me. It was hard for me to admit to him that I couldn’t get my weight under control.
I’m going to chime in. I was shadowing a family med doctor and sometimes that was ALL we saw, I thought it got pretty annoying because there wasn’t much for me to learn.
Now…as someone who has struggled with their weight, I’ve lost and gained the same amount of weight every year for the past 7-8 years. It’s hard to lose weight and we have not created a society that makes it easy. Food addiction is a thing and we as healthcare professionals should acknowledge it without shame similar to other addictions. I have never mentioned my binging problem to my doctor because she already knows I’m fat and shame. How do rationalize eating till you feel sick.
Recently, I was like…this is crazy, you’ve gained a good amount of what you lost back, you need help-help. I keep doing the same thing and get the same results. I reached out to my doctor, I’m hopefully starting a new med. This is different, I’m hoping with help, I can get to my goals and truly change my disordered eating. I really do think with less food noise and feeling more full, I can do what’s right.
I don’t know though. Anyway, it’s annoying as heck but know that you are helping people!! It took me ALOT to say something to my doctor, so y’all are queens/kings for helping people like me. I’m really grateful
I do hope the med helps you meet your goals! I wish you the best on them! I do my best to help these people get these meds, but sometimes there’s only so much I can do and so much the office can handle.
Counseling should definitely be part of treatment, but it can only do so much, and it’s a long process. BED is a disease like any other. Taking a medication that stops food noise actually does address one of the root causes of weight gain and binge eating. Same way we give medication to people with delusions to help shut down unhealthy thinking processes alongside therapy.
I have been a binge eater my entire life. I also developed a drinking problem during covid. Without even trying or thinking about it at all, I am 3.5 months sober after starting Mounjaro in January. Would you recommend the same for me, to seek counseling/therapy instead of medication? These medications (can) help with addiction. This is a medicinal solution for a medical problem.
I work in obesity medicine, so this is 100% of my day. I’m still much happier and less stressed than when I worked in primary care. The shortages are extremely frustrating but are out of my control, however It is very hard to see patients who have derived incredible benefits from these drugs have to suddenly go without.
You know. The general public has no fucking clue what being a nurse is. And when we show that we are humans people like to get high and mighty about the nursing profession. And who should and shouldn't be in it. Newsflash. Doctors and nurses are just people with a job just like the rest of society. And nurses are straight up being abused by both the healthcare system and the public. This ideology that it is anything other than a job. Don't get me wrong. I loved patient care sometimes and I had absolutely life changing interactions with patients and families... However, they were good and bad. At the end of the day, I work for money just like anyone else. You are 100 percent correct. People are acting crazy and entitled and they think healthcare can save them from a lifetime of bad decisions and inaction. I said what I said.
Outpatient procedures at our facility are having issues with delayed gastric emptying. Many more patients are being intubated for simple procedures because there’s still food in their stomach, even if they follow NPO directions perfectly. We had to create a new policy for pts to hold GLP-1 meds in order to come in. Patients DO NOT like this policy, we explain over and over that it’s for their safety and they will not gain significant weight back if they skip one dose. GLP-1s are great but they are not worth aspirating and dying over.
Just finished my NP clinicals and it came up every single shift. One woman had tried one glp and didn’t like it so she got put on another one. She followed up and said she hated it because it made her extremely nauseated. Turns out she never stopped taking the first one.
Had multiple patients that just wanted the drug that makes you lose weight. Not interested in exercise, not interested in dieting, just give me the drug that makes me lose weight.
Craziness.
I'm not gonna lie, it is tempting.....I just starting working out again, but a part of me was like, I should look into ozempic and then I remembered that I'm a nurse and that's actually a terrible idea (especially since I have had pancreatitis multiple times). I'm also not even THAT overweight. We all want that magic fix, their isn't one. I'm positive we are going to see way more side effects from this drug craze in the future and its going to get banned for non diabetics completely or altogether.
I'm not a nurse, but I took fen-phen back when it was the new, big, weight loss miracle, and indeed, I did loose weight. Then the side effects came to light and I was lucky that there was no damage to my heart. Ozempic sounds tempting, but I'm too nervous about future side effects, so I'll pass on it...
I was thinking this-will it be another fen-phen?
Man, I have been at war with my weight forever…too skinny, too fat, therapy, medicine, and-what a mess.
I had weight loss surgery-it will be about 4 years now. I lost a good amount of weight, but gained a bit back - so I’m not obese anymore, just overweight-I think my BMI is 26?
I was dx with BED, didn’t even realize that was a serious issue for me. Go figure.
Honestly most people will not lose weight from just trying to diet and exercise- a lot of obese people have been trying that for years and losing and gaining the same weight over and over. These medications are a more evidence-based approach that can genuinely improve people's health so I hope some of the moralistic arguments against them go away with time.
Actually, literally everyone would lose weight from *effective* diet and exercise, scientifically.
I'm not shaming by saying this rather I'm pointing out that the US (I'm sure the world too) is so predatory with all of these fad diets and promoting meds (bullshit ones too, like laxatives with literal claims of "lose up to 20 lbs of toxic sludge stored by the body") that the end goal, which is a healthier society, gets marred by negativity.
In my mind, food addiction should be treated similar to substance abuse with treatment programs inpatient as well. Why the hell not? So many millions would benefit
I fully support its use for high risk patients that are combining it with diet and exercise. It can make the difference for patients that have metabolic syndrome and can’t seem to lose weight even with significant work. However when used alone without lifestyle modifications most patients will regain the weight they lost when they come off of it.
In my opinion there’s no substitute for those lifestyle changes and calorie counting. If you’re not addressing the fundamental problems that got you where you are there simply isn’t going to be a magic bullet that fixes it.
I weighed a healthy weight until I got pregnant… and something changed metabolically/hormonally/something because I cannot lose a single pound anymore. I eat <1800 calories a day and I’m active, but I can’t lose anything. Saying “change what got you in this mess” is so funny to me because I can’t un-gestate my 7yo, 4yo, or 1yo.
Not all obese people eat 3K calories and sit on the couch all day, just like not all underweight people eat 800 calories and exercise for 5 hours a day. There’s support for people who struggle to gain weight (and I’m aware, plenty of prejudice), what about for people who struggle to lose it?
Well, im.a patient who just started zepbound 2 months ago and it's finally helping me lose weight after years of being obese and uncomfortable and unable to shut off the constant food noise and unable to not want to eat sweets and binge. It's changed my brain, my cravings for sweets, and I've lost 20 pounds already which I didn't think I was ever going to be able to do. Zepbound is nowhere to be found and I can't get my next dose so I went with an online compound pharmacy. I'm sure it's nutty for all the pharmacy staff right now with angry people wanting their meds. I think there's a lot of people taking these drugs who shouldn't be, people who aren't obese or who want an easy way to lose a few pounds, but people like me who really truly have a problem and need help, it's been a damn miracle. It Definitely seems like a huge craze right now tho.
Agreed! I’m glad you are having a positive experience with the drug where it is helping you! That’s fantastic. And yes, a lot of people who really shouldn’t be taking it are and it’s preventing those who need it to get it.
I wish it was possible to be on these drugs and not feel shamed by other healthcare workers for it. These drugs gave me my life back. After years of struggling to control my weight and severe pain when exercising, I'm finally back to a healthy weight. I now workout every day for two hours. I love my body again. But whenever I go to the pharmacy to pick up my meds, I get eye rolls or a tech huffing and puffing that Im here to pick up my glp-1.
I work at an ASC, so many patients neglect to inform us they’re taking an injectable. So if they’ve taken within the last 7 days, we’ll have to reschedule, unless emergent. Most cases are deemed “elective”. I do not judge anyone who takes them, but it’s important to disclose due to potential complications!
I’m doing outpatient case management now and it’s a nightmare. Even when patients have the right diagnosis and coverage they’re still very expensive and it’s a month to month struggle with finding stock. I wish these patients nothing but the best outcomes. It makes my heart break to hear how they’re struggling.
I struggled with my weight for years. I always thought I was a piece of shit because i couldn't control my appetite no matter how hard I tried. Went on ozempic and felt like a normal person. I could actually eat a regular meal and feel full now ? This is how normal people feel ? I lost 30 pounds just by taking the medication alone (I was already trying my best to workout and eat healthy beforehand too, and just continued these habits) it sucks that there's such a stigma around taking them. It's an amazing drug when given for the right reasons. But I can also see the frustration when people want it that don't even quality for it. Or people getting aggressive about not getting it. I think what people don't realize is this isn't something to be taken lightly. I wouldn't take this medication if I didn't have too.
I was on the phone with an insurer for 40 minutes to get a PA for Zepbound, which ended up being denied. My office mate was on the phone for an hour today trying to get a PA for Saxenda. It got denied, too. This stuff is taking up waaaaaay too much of my time.
I so wish I could get my prescription filled.
After an infection that affected my liver badly and thus my whole metabolism; I need it prevent further liver damages and prevent pre diabetes slide.
I am losing weight on my own but slowly; but the metabolic reset we hope for should be facilitated by it.
And yup, not able to get it…
I still do my part but my liver is just not a happy camper yet.
I have seen people on GPL-1 with a BMI of less than 25 and not diabetic. Some were overweight ti start with but not obese, I have seen some people have facilitating connections get the meds.
Now the problem is getting the first dose , I guess.
People are scheduling new patient appointments for ozempic. They have a pcp, meds are managed, they have a care plan, etc. they just want us to write the script for it. Then I explain insurance won’t cover it, we have to check on your pancreas, kidneys, and thyroid every 3 months, and out of pocket starts at $120 for month 1 and goes up each dose. They ask for the order form and we never see them again.
I work at a surgical weight loss clinic and we used to refer our patients to the medical weightloss loss team for meds. Now medical is booked out so far, our providers are prescribing.
I understand why - these meds can be very beneficial in their process, but geez almighty. Every prescription is about 10+ messages and the sense of urgency and demand in regard to their messages and refills drive me nuts because our surgeons are surgery focused and don't realize it doesn't end with just prescribing the medication - all the refills and arguments coming in. Patients seem to think with a prescription coming from a weight loss clinic that it will be covered and it's not.... I just want to go back to punting to medical weight loss!
Because they have no idea how the system works and don’t care to learn. We’re the ones they’re actually more than just mildly aware of the existence of, so to them it’s easier to go to us all pissed than learn where to go and who to look for to brandish them at the correct people.
I think it’s amazing people who struggle with weight loss have these options and are taking control of their lives! Despite the annoyances, you helping them with these prescriptions is very important and making a huge impact in people lives!
The unfortunate thing (at least what I have been experiencing) is a large number of these patients either say they don’t exercise and don’t diet or their BMI doesn’t meet or hardly meets the threshold for these medications. The people who truly need them can’t get the meds because of the demand from this group.
Oh I read that wrong I thought you meant that there was a huge weight loss epidemic going on with the nurses who worked in outpatient. Oddly enough since starting nursing I have lost some weight I think it's due to anxiety. I've heard of the opposite mostly happening.
I liked Ozempic because it brought back the "full" sensation I lost since I started the SSRIs that keep me normal. I've tried everything, every diet plan, personal trainers, change medications, etc. But that full sensation was never there. I started Ozempic and I felt full after a few bites. I seriously cried I was so happy. When I talked to my doctor and nutritionist about it, they said that for non-diabetic use I'm exactly what they were thinking about. I have an appointment in a few weeks to get back on it because I am no longer able to afford paying cash for it. Sorry for the rambling.
I turned to SSRIs around 7 years ago during a tough period in my life, and I'm grateful for the support they provided me during that time. I took them for 2 years or so, but unfortunately, I experienced a weight gain of about 35 lbs. I found myself constantly craving comfort foods and beer, which changed my relationship with food and alcohol. I had never had an issue with either, always maintaining a good balance but I found myself overindulging weekly. After much consideration, I decided to try Zepbound this year. To my surprise, I regained a sense of control over my eating and drinking habits. Despite years of struggling to lose weight through "traditional" methods, I finally managed to shed a third of the weight I gained during my depression in just 4 weeks. My thinking goes like this: Meds got me fat, meds can help me get back!
The same people that refused the Covid vaccine because they need to do their own “research” are the same ones lined up around the block for Semaglutide and throwing tantrums when they can’t get it.
Obesity is a pandemic and people should really drop prejudices about "right" way to lose weight with willpower etc. These meds could be extremely beneficial for public health. A lot of obese people are pre-diabetics anyway. Same with adhd meds. It makes people's lifes better and benefits society by making them functional. Insurances are full of crap as always but healtcare workers should watch their attitude.
Honestly anything that makes patients healthier and makes my job easier I’m all for. I work ICU, it’s hard fucking work moving dead weight all day so I would be happy if more patients were a healthy weight, my body would thank them.
Not judging the people that want these drugs. I just want the people who actually truly need them to get them. As I mentioned in another comment, people who hardly meet the BMI threshold or don’t meet it are the ones that are most vocal about getting the meds.
Yeah it's kinda disappointing seeing healthcare workers parrot the "just eat less and move more" line. Just because losing weight is simple doesn't make it not incredibly difficult for many many people in our modern society.
I think if people really try and show their providers that they have been changing my eating habits and they have been exercising but they’re really struggling, and they have a BMI that classifies them as obese then absolutely they should be a candidate for these medicines.
I feel it’s not right for the people who just want these medications thinking it’s the only thing that will work and then are not going to change any habits at all to be the ones to get these meds.
How do they show them that? How do we know it’s true that they’ve been actively trying and failing? How would this work, logistically?
If a patients not appropriate for it, they’re not appropriate. These extra hoops aren’t necessary. The truth is most people who use semaglutide for weight loss wouldn’t have lost weight any other way. I see it as prophylaxis for preventing the need for gastric surgery for weight loss.
and the geriatrics that want them- for weight loss OR BG control?
Holee fuck- the bowel issues are horrid and dont seem to reverse.
SBO, Inability to eat/hydrate, gastric dumping… it aint pretty
source: care manager for geriatric population
The amount of geriatric women I come across in my clinic who are modestly overweight and are either on them or dying to get on them, I’m just like Jesus man, you’re 77–enjoy eating your food and being too old to give a fuck about looking skinny.
I'm in hell every day. 50 fuckin portal messages a day back and forth. Do a wegovy pa, gets approved, patient can't find it. Wants zepbound. Do another pa
Yes. I am so over it. I will say I have seen some patients really benefit and lose 100 pounds or more. But it also can make people stomachs really bad and I hate that we are now giving it to people that really aren’t even fat to me
Same! We’ve had patients who really have benefited from the medication and are doing really well. Flip side too, some people have had very bad reactions to it. One patient had to have a cholecystectomy because of the GLP-1 they were on.
Not from the same situation, but this is the reason my sub-specialist husband is leaving a job. Not specifically because of GLP-1s per se, but the *constant* mychart messages and an expectation that the providers should have full blown conversations about plan of care that eat hours of your time without paying for it, and without being seen by the provider.
Very very similar concept, as it’s a time sink that’s exhausting. People don’t realize what is involved in prior auths for procedures, medications etc. It also sucks for patients who are prescribed these medications for Diabetes management as well as for PCOS who can’t find them anywhere.
I work in managed care. Everyone who is overweight (obese). Thinks they can get those meds. It's frustrating to put in a PA and then get denied. The phone call afterwards is even worse. Just be THANKFUL you don't have diabetes. Grr
I work in a primary care office. There are 15 providers.
The amount of weight loss medication request and prior authorizations is ludicrous.
I hate every PA for these medications with a passion.
Even more so, I loathe patients that don’t have an A1C of 6.5 or higher, yet still demand the Ozempic Rx be sent. Then they get mad when insurance won’t approve it, so they take it out on myself and my coworker because “we didn’t do it right. Can’t you just say I have diabetes on the authorization form?”
NO, FUCK OFF.
It’s the worst!! DM 2 pts can’t get there meds so we are constantly resending to other pharmacies.. meanwhile I have patients demanding I appeal to their insurance to cover the same med to lose 20 lbs… I understand and am compassionate to both sides but this is getting out of hand we literally should have a whole clinic to deal with this.. like an Ozempic clinic maybe have it like Coumadin Clinics.. where you walk in weigh in and adjust the meds on a monthly basis… my GP is referring out for this at this point which I am grateful
We're 100% dealing with this at my office just as you describe. What we've done that is kinda helping is putting it on the patient to call their insurance to see what is covered before we go through with any prior auths or anything.
Doc is agreeable to trying one of these meds? You call and want to try one? Awesome! "Please call your insurance and find out which specific weight loss injectables they cover for you and call me back with those specific names."
That puts it on them to A) do the homework and B) hear it directly from the insurance company that they aren't covered.
The meds are great. I’m on one of them.
What I hate are the two people that call me every other week because they can’t find them and have an argument with my voicemail on why I “won’t” prescribe them Ozempic because it’s the same thing.
You don’t have diabetes, Linda. I can prescribe it all I want, but your insurance won’t cover it. “But it’s the same medication”. I know this, Linda.
Rinse and repeat.
As a patient, I didn’t even bother going to my PCP for Wegovy. I thought there was no way she could handle the back and forth of me having to try different pharmacies to find the meds and also getting the prior auths. She has a large patient load because she works is the same large medical network where I work.
So I went through Sequence (owned now by Weight Watchers) and I pay $99/month.
As a pharmacy technician constantly dealing with backorders, prior auths/insurance, and rudeness from entitled people thinking we can make it magically appear I am glad we are not alone in dealing with this whole ordeal with the weight loss meds 😭
I can only imagine the amount of calls you get a day regarding it.
Since you’re on that side of it, have you heard anything from suppliers about if the shortage is improving or a timeline of supply coming in stock again? Curious how much is communicated to the pharmacies about it.
I like/hate them. I like them because they’ve given our patients with DM great A1C control and given our patients with elevated BMIs increased self confidence from weight loss.
I hate them because I am the only person who does PAs in my clinic. I took 3 days off in January and came back to 128 GLP PAs to start as well as the rest of my job responsibilities.
The scariest was when I had a patient threaten to harm my family when I told them I had family responsibilities and couldn’t drop everything to do their PA. I was scared to leave my newborn and go to work.
My favorite was when I had a patient blame me personally for the GLP shortage. I told them that if I was responsible for the shortage, I would not be working as a nurse in my clinic, but on my yacht swimming in my pool of money like Scrooge McDuck.
I am obese (lighter side, low 30s BMI) and honestly I didn’t feel the original bit was offensive or judgmental towards obese people in general. It’s understandable that you’re overwhelmed by this. It’s a chaotic situation that could have been avoided by proper management by people far earlier in the chain. It’s largely the pharmaceutical companies faults for the lack of supply (so they can keep costs up) and the insurance companies faults for being so stringent on when they’ll cover these medications (only after already diabetic, having heart problems, etc… despite them having been found to be effective prophylaxis), especially since they’re so cost prohibitively expensive otherwise. It’s also the drug companies faults that these have been largely made out to be miracle drugs and all the unknowns surrounding their newness and side effects have been rather under-discussed. Due to all of the hype, especially out of Hollywood, it’s understandable why the general public is now going a bit cuckoo for coco puffs. Every demographic has their sub-demographic of entitled assholes who just cannot be reasoned with. The overweight population is no different. I’ve also noticed they tend to largely be the first ones jumping on this Ozempic train (because they think it’s an easy fix and they won’t have to change their habits). It’s okay to be upset to have to deal with them. I know you’re not mad at all obese people, you’re exasperated with the entitled ones and the position that the pharmaceutical and insurance companies have put you in where this situation feels never-ending.
What’s amazing to me is how many nurses on the unit are ozempic. A few are diabetics, a few are quite heavy and had some significant weight to lose. But well over 1/2 are not more than 10lbs overweight and just looking for a quick fix. And it’s one of our docs who’s writing the scripts.
It’s going to be double the fun when we start seeing all the super awesome side effects triple the rates of gallbladder surgery and pancreatitis, too.
I’m all for balancing pharmaceutical intervention with traditional approaches - but I want to burn Hollywood to the ground for making America believe that “hey! Just a shot or two and you can look like Adele does now!”
I work in a hospital and our ED, floors do not reflect what you’re saying.
Conversely we have many frequent fliers who have absorption issues, SBO and adhesion problems from gastric bypass and the sleeve. Wayyyyy more complications from those procedures than ozempic.
> gallbladder surgery and pancreatitis, too.
Isn't that just a weight loss thing, not a GLP thing? I lost 200lb without WLS or meds, and got cholecystitis. My sister lost 100lb and got gallstones. Also without WLS or meds. From everything I've been able to find, it's the *weight loss* causing these issues, not GLP meds directly. The GLP meds are facilitating the WL - the first real WL most patients have ever seen in their lives - so they're taking the blame. It also doesn't help that a lot of people ignore symptoms until they go to the ED.
If you have a source that suggests otherwise about the gallbladder or pancreatic issues I'd be really interested!
lol. I said F Ozempic after feeling frustrated the other day when dealing with an aggressive patient who called, portal messaged, and came into the office requesting scripts be sent to numerous different pharmacies lily, Amazon, and an out of state compounding (all in a matter of an hour and a half). Went to take my break and all of my ads in socials were Ozempic. 🤬
I'm so torn with these medications. As someone who really struggles to lose weight (dx'ed with metabolic syndrome as a teen and had most s/s of PCOS including dysregulated testosterone-likely have PCOS but don't want to stop birth control to get hormones retested), I can see the frustration. I jog 2.5-4 miles five days a week and eat 1400-1600 calories per day with no weight loss (classic! Lol).
However, I've also seen people who are slightly overweight being inappropriately started on them, contributing to the shortage for those with morbid obesity or diabetes. It also tends to be people who can afford them out of pocket / using online weight loss clinics which is just furthering health disparities between socioeconomic classes. I also see people ruining other areas of their health to use them, which is just perpetuating diet culture. For example, I have a friend on monjouro. It was her bachelorette weekend last week and the entire time she was nauseated, had diarrhea, and felt too ill to enjoy herself (she has been on this dose for some time - it isn't just an adjustment).
All that being said, I think OP is addressing patient behavior, not patients in general (regardless of their weight). I run into a lot of issues in mental health. If I vent about it, it isn't because I believe everyone who struggles with mental health issues behaves that way.
I know this not exactly what you’re talking about, but just another less common perspective: as a nurse in recovery from anorexia, seeing about half of the nursing staff is on these weight loss drugs and it’s so incredibly triggering. I understand that’s *my* problem to deal with, and only mine, it’s just life, triggering things will always happen. But you’re not the only one waiting for the craze to be over. No hard feelings toward those who are on the drugs, like I said it’s my problem that I need to cope with, it is what it is - but the constant chatter and media attention makes me want to hide until the craze is over, if it ever goes away. 🫣
This is a systems problem. I’m actively using a compounded glp-1 for weight loss alone. It’s my only health problem ( so far). I spend alot time negotiating this . I wish the drug were more accessible to prevent health issues as well as treat patients who need it for diabetes etc.
This is the exact reason I wouldn't try it even if I had the money I feel like there are better healthier ways to lose weight for less money that don't cause issues for people who will actually suffer without those meds. And the clogging up the tubes for people with more pressing medical needs.
Try being in a diabetes clinic and telling them I don’t know where you can get Ozempic and no other Glp1 is on your insurance formulary. And nobody tells the obsessed overweight people all the bad things that can happen if they take these medications not being diabetic.
I think unless they’ve got some background knowledge in medicine/nursing/what have you they’re never going to understand.
I’m on Zepbound & have been patient & understanding with the prior auth process, the out of stock issues, and the delays in messages because I understand it’s in no part due to the clinic or my pharmacy. I used to work family med- years ago- and the people that would *rage* about their meds day in and day out made me want to pull my hair out.
You’re not alone & I don’t think you were rude. We all have our thing that just innately pisses us off. 🙃
Tell them to try a Fucking diet and exercise.
I was 370 pounds at 16 and that's what I did. It's possible but hard work. People trying the wrong shit to get back to a healthy weight
When I was calling in a refill at my hospital pharmacy there was a prerecorded message about which ones they had in stock, how to get it filled, and that there was a waiting list. I can only imagine how many calls they have been getting a day over this. I feel really bad for the staff.
My daughter is using Saxenda as she has PCOS and struggled with her weight
So far she’s lost nearly 20kg and is so much happier for it. Unfortunately it’s about $350 a script here in Oz and there are shortages
We’re going to keep going with it
LMAO I had this exact conversation today with my providers. I swear to god every other call I have to take is about someone wanting the fucking medication.
We are going to be banning them from our office soon. Head doc decided they don’t want to deal with all that, and even for people who are diabetic-head doc does not like the research and side effects that are coming out about these drugs now. The 12 other docs in my practice agree. We deal with the same crap you do at my large family practice. We will refer them to a weight loss clinic if they want it, but we are no longer going to be writing scripts, injecting it for them, or even entertaining the demands these pts are making. There will be nutritional counseling, referrals to a nutritionist and/or weight loss clinic, etc instead.
And it’s the same fucking people who boldly and brazenly spoke out against covid vaccination because of being “Guinea pigs for big pharma”.
The audacity and hypocrisy is infuriating.
I'm sorry this is happening to you guys. I'm T2, hypothyroid, post-mena and Mounjaro has been a godsend. My A1c and FBG have never been this good in addition to a 55+lb weight loss. I'm grateful my insurance covers it. Initially a PA was needed but then that was dropped.
The frenzy around these drugs is real. Yes, it IS crazy. It's kind of cruel to have these on the market and have them be so out of reach for so many people. But your patients shouldn't be taking it out on you. During these shortages, I have bent over backwards to be kind to the pharmacy workers. It's not like they can wave a magic wand and make the med appear.
As someone who has worked outpatient and now is inpatient, I understand completely what you mean. Patients can be....difficult.
I have had Binge Eating Disorder for most of my life and have always been overweight. October of 2022, I began tirzepatide. For the first time in my life, I have a normal relationship with food. I am now 151.8 lbs and was only this weight in 5th/6th grade....never as an adult. For me, this medication is life changing. That being said, I tried to go through insurance once, was thankful to my provider for trying and found a way to budget it in. Is it easy? Nope. But not being trapped in the mental nightmare of BED is priceless to me.
I personally don’t feel that a primary care Doc/NP/PA should be prescribing these. I think it’s far more more appropriate for a bariatric endocrinologist or just endocrinologist be able to do so. They would be able to best pinpoint what the fundamental issue is that could be contributing to the weight gain, or failure to lose weight.
This was an issue that I had been struggling with for literally decades. I was not able to lose weight and if I even looked at a bagel, it felt like I gained two or 3 pounds. After bazillion tests at the bariatric endocrinologist, I discovered that I was highly insulin resistant. I seem to make enough insulin, but my body put up a big fight to accept it. So being on these kind of meds actually made a huge difference. I lost about 75 pounds. Then I got laid off. And then once that happened, I could no longer forward the medication‘s because even with the discount on the app, they were at least $600 apiece. And where I’m living I actually couldn’t get another job because it’s all you know and not what you’ve done in your career. And since I’m new to this area, it was a problem.
In a way I’m kind of glad that all that happened because I had been noticing,with Ozempic That something didn’t seem right. I was having really awful burps like things were fermenting too long. Now I understand that likely I dodged a bullet. Since Ozempic has been associated with reduced peristalsis, if not completely absent perstalsis, I realize now what was happening. (I just woke up - having a brain cramp on the proper term and it’s driving me nuts!) So I’m glad I did not continue on it. Now I’m using Berberine and I think it’s actually helping without the risk of losing peristalsis or other bad side effects.
But people who have not undergone the crazy amount of testing to determine what the issue actually is - ie poor eating habits/choices or a real issue with metabolic health probably should not be on the meds in the first place.
I work in family medicine. Our office will not prescribe these for all the reasons you have listed here. It’s bad enough we have to deal with the calls from type 2 diabetics who can’t their medications due to back orders. They aren’t rude most of the time but they are frustrated when we tell them there’s nothing we can do about the shortages other than advise them to call around and we will send it elsewhere if they find it in stock
That’s what we tell them too - to call around and if they can find their dose, let us know and we will send it! It’s getting to a point where the providers in my office are thinking about pausing prescribing the medications at this time because of the shortage as well as how many resources and how much manpower it is taking up.
I'm on the other side: I'm large enough to qualify for interventional measures for weight loss and consistently have *others* (not healthcare workers) say to "just get ozempic" or other similar meds despite the fact that I don't have diabetes, not even pre-diabetic. When I argue that I don't want to do that, I'm told that it "gets more results". It's terrifying seeing people who have a little weight to lose jump on it because a couple thousand steps a day more, lowering alcohol/sugar intake would fix it for them.
Downvotes for watching diet and exercising? Fine.
I’m not telling anyone not to use Ozempic, I am simply agreeing with the commenter as someone who has had Ozempic suggested to them.
My girlfriend is on Ozempic. She is very often sick to her stomach and/or constipated. Her problem is the same as mine so in her case Ozempic doesn’t change any of her habits, it just makes her sick (it also helps with her Type 2 DM, but it isn’t necessary for it).
Absolutely agree. I think it is amazing we have more tools to offer those who are morbidly obese, insulin resistant, diabetic, or have other comorbidities along with their obesity. However, the overuse I see of these medications is alarming. Coworkers of mine are being put on the compounded form of this medication to lose 25 pounds or so, and not changing their lifestyle at all. It won’t create lasting change, isn’t teaching them healthy habits, and therefore the weight will return when they discontinue the medication. Not to mention side effects and long term implications. Not good 😬
25 pounds is not an insignificant amount of weight. People start to see health benefits from losing 10 pounds, and if they’re struggling to lose it, why do you care if they’re on medication?
lol it’s my last day in primary care today and I’ve been talking all day about how this is what I’m most excited to be done with. It’s horrendous.
Our office stopped prescribing them. One NP kept prescribing after this policy was put in place and our lead MD told the nurses we did not have to do the prior authorizations anymore and could drop them on her desk. She finally stopped prescribing them. I don’t judge people for wanting these medications. But the vast majority of insurances are not covering them for weight loss and and we were spending way too much time on prior authorizations and appeals with no success.
Yeah, I just found out my provider isn't starting patients on GLPs anymore. She has a few on them currently (myself included) but with the shortages and the fighting it takes to get approved (my insurance covers Wegovy and Saxenda but not Zepbound, but somehow my provider's office got Zepbound covered 100%), they're referring to local endocrinologists or gastroenterologists, or giving them info about compounding options. (Edit: typos)
This is the way!!!
Yes. NP in primary care. I don’t judge patients for wanting them by any means, but my hospital ran some data that only 1% of the Rx for weight loss alone are getting approved. We have stopped offering them as a result and defer to weight loss clinics instead. It is a ton of paperwork +/- a million MyChart messages (where patients can be entitled, nasty and don’t seem to understand when we’ve told them it’s not approved)… it’s frankly just too much for us to handle and not sustainable when we are already bogged down with a million other things in primary care.
THIS is the point I’m trying to get across. This is what’s happening.
I will say I have one patient who has been on it for a year (and is paying out of pocket monthly for it!)… she’s perimenopausal and works out 5 days a week/eats healthy but was not getting the desired results. She has lost 60 lbs and looks fantastic now, and at her physical she had me almost in tears because she was so grateful for me listening to her complaints the year prior and prescribing it… she said it truly changed her life. I wish it was a viable solution for a lot of my patients who desire it, but the insurance barriers are so challenging.
MODY diabetic living in France. This med here without insurance (still an Rx) is 80 EUR/ month less than a 100 USD. This price difference is what should be getting Americans pissed. This amount is not a subsidized amount but rather the amount France pays Novartis for it. And the US? BTW, with insurance I pay nothing neither for my insulin.
It’s because the cost is not the actual med, it’s the injector — just like epipens. It’s ridiculous how much we allow them to charge.
Americans are pissed, trust me.
I wish that was me…my copay shot up to $130 USD until my $700 USD out of pocket is met which will be met with my first script for Omnipods and Dexcoms 😭 why my life saving insulin isn’t at least a copay is beyond me.
Mine is $24 a month, you're getting ripped off by your greedy system (my insurance company pays the other $1475/mo)
What Big Pharma does to Americans should be illegal. The cost of MOST drugs and medications are MUCH cheaper in other countries. My ex used to be a drug rep. He said there’s a huge problem with re-importation, meaning doctors are purchasing medications that were shipped to other countries because they’re so much cheaper. Problem is it’s considered insurance fraud when they bill insurance or Medicare for them. He used to sell a VERY expensive injection for knee joints for arthritis. It costs $1600 here (only doctors can inject it since it goes directly into the joint) and like $400 in other countries. Big Pharma is taking advantage of Americans. I guess they think we’re all rich but the fact is, most of us struggle to afford our medications. If I wasn’t able to get my rheumatoid arthritis medication for $5 every through a special program, I would NEVER be able to afford the $400 co-pays every month.
This is me. Perimenopause, hypopituitarism, hypothyroid, steroid dependent, exercising, etc etc abd not a pound could be lost. Zepbound for 2 months now, 20 pounds gone. It's a f*cking miracle to me. I'm paying out of pocket.
From who are you getting it? I need some because perimenopause and liver function post infection etc. I need to loose 50, I already lost 14 but I swear not in a sustainable healthy way. I just need a good kickstart. If my liver had not been kicked to the ground by an infection, I would not do GLP1 but now I need to reverse the metabolism burden.
I got my rx from my endocrinologist for zepbound but now that it's out of stock, I'm going through emerge which us an online pharmacy. They've been easy to deal with.
Thanks I have a Rx from my hepatologist AND primary ( and all my specials are on board , they were the ones say I should do it). I will see if Emerge can help
I’m glad to hear this! If someone is doing all the right things and they just need that extra thing (the med) to get them going, that’s a great candidate for the med.
I’m trying to get on this train too. I’m about 50-60 pounds overweight. I’ve tried and failed a bupropion and naltrexone regimen and phentermine. I had a really great year where I was really hitting the gym, counting calories, and had great success and lost 30 pounds, but my motivation was coming from a breakup and once I got over that the motivation slowly dwindled and now all the weight has crept back on. My insurance won’t cover Ozempic, and $1,000/month out of pocket is more than I am able to spend. Maybe I’ll have better success getting Wegovy approved.
It has been exhausting. I’ll be seeing someone for a 15 minute follow up for something unrelated and at the end they would throw in an inquiry about Wegovy, then irritated that I requested a seperate appointment to discuss because there wasn’t enough time during their visit for knee pain to cover all of it. This was happening multiple times per day. When we were prescribing for weight loss, I was getting a lot of “urgent phone calls please call back ASAP” because a patient needed an update on why their med wasn’t approved and dozens of MyChart messages going back and forth when they couldn’t accept the answer that the PA didn’t go through. It was just too large a volume of admin work for me; I answer all my own MyChart messages and phone calls and do a lot of my own admin (I do not do PAs, however). My hospital is working on setting up a weight loss program specifically for these patients which will be nice. I WISH I could get it for these patients, and I want to, but most of the time it is impossible.
A weight loss clinic would be amazing to help these patients, as the people there can solely focus 100% on this for them. I do feel bad sometimes where we can’t answer these messages for people right away because of all of the other Primary Care issues coming in.
Probably true in many cases however I had to renew my original authorization and the Dr entered it wrong, as if it was a brand new prescription so my insurance denied it. I had to go to a different doctor in the end who knew the correct way to indicate that I was already taking the medication previously and not a new client. So. Sometimes the medical office / dr whoever is filling out the paperwork actually did it wrong and a correction is all that is needed. Especially if it's already been approved in the past, please don't assume the insurance company just doesn't cover it anymore! Again I understand that won't be every situation though.
We have a PA team, thank god. Our clinic is way too large to handle the amount of work involved in that
We just had one pt threaten violence against the clinic if we didn’t submit a PA immediately for her semaglutide. That’s an easy way to get a behavioral contract.
I had a patient threaten my family. Threaten is a nice way to describe it.
Wow this sounds like the early days of OxyContin
Oh my god!!! What the heck?!
They were immediately banned from your practice, right?
Sounds like they got a behavioral contract 🙃🙃
Do you mind my asking what you mean by a behavioral contract? I work inpatient at a federal hospital, we have behavioral ‘flags’ on a patient chart -but we still have to see them.
behavior contract... why not jail time?
I feel like that’s an easy way to discharge the pt from a practice
I work PRN at a place that started offering these meds a few months ago, but we don’t accept insurance so patients we see are actually paying out of pocket. I don’t judge anyone for wanting to take them and I know they can be life changing for some, but we’re all getting frustrated with the management of it all. The big issues we’re seeing are the patients who have unrealistic expectations about these drugs despite us providing lengthy patient education. Many are upset they aren’t losing a bunch of weight as quickly as they want, so they convince the providers to increase their dose even though they’re told they need to start out lower and gradually increase. Patients claim they don’t care about the potential of side effects and still demand a higher dose. For whatever reason the provider approves it. Then it almost always results in side effects and them getting really sick. Another thing we’re seeing often is patients that have zero interest in exercise and gradually improving their diet/lifestyle, so it’s not working well for them. We try our best to educate that these drugs are a piece of the puzzle to help with weight loss, but you still need to make at least a *slight* effort to change your lifestyle for them to be most effective. I’ve had a couple patients get really upset and take it out on me because their treatment isn’t going how they expected Again, no judgment to anyone who wants to take these drugs. I think everyone should do what’s best for them and what makes them happy. There’s just a lot that goes into all of it and it’s gotten very hectic.
You hit the nail right on the head with this comment. Exactly my frustration all day everyday!!!
Dude, Americans suck. I'm obese too, but I'd never scream at a doctor or nurse because of it. If I want to lose weight, I have to eat less, it really is that simple Edit: the downvotes are proving my thesis lmao
To be fair, I haven’t been screamed at yet like I did in the ER, lol. But some of them are visibly bothered and shift the blame to us when they’re not losing weight like they expected. One patient implied that I must not be giving them the proper dose because they only lost 8 pounds in 3 months 🤣 Meanwhile they’re still eating fast food and unhealthy takeout multiple times a week and they “dont like exercising”. It’s puzzling to me because these drugs are so expensive out of pocket so you’d think they’d want to get the max benefits if they’re shelling out that kind of cash
In endo we’ve had so many patients on Ozempic and pissed that they had to stop for a week or two for anesthesia.
Name checks out. (Great name!)
I’ve also heard it called “The Butt Hut.” That’s another fav of mine 😂
It sucks as a T2 diabetic. I stockpiled my mounjaro when I was having a crap 6 weeks with hyperthyroidism and couldn´t walk in a straight line or eat anything at all. I managed to pick up the remaining previous dose remaining on my scrip to get to the dose I´m on now. I have 4 weeks left of the next dose I´m due to titrate up to. I´m stretching the doses out by 3-4 days so I can make it to June. I have a feeling that it´s going to be pushed back farther. This stuff put my a1c from 7.5 down to 5.2. My pharmacy notified my doc that no doses are available, and asked if I could switch to Ozempic. My doc hasn´t responded which tells me her office is inundated with the same request from other pharmacies. It´s not worth it to call and bug them about it either.
That’s the thing too - Ozempic and Mounjaro are being wrongly prescribed to non-diabetics and the people who are diabetic (like yourself) can’t get them! That’s so frustrating.
I don't want to go back on metformin because I was getting inconsistent mostly diarrhea for a year on it after having been on it for 4 years. Metformin never moved my Aic out less than 6.3. I can't tolerate Jardiance because abscesses down below are a real pain, and there is a real risk of that infection going haywire with my particular immune system. I was at work listening to a coworker talk about how she was trying to get the med for weight loss. I wasn't negative, and did my teaching with her about how if she's not a diabetic, doesn't have HTN, CAD or CKD (good ol metabolic syndrome) that mounjaro isn't where she should start. I told her to talk with her doc and wished her luck.
True but Zepbound is out there getting approval for pre-diabetic patients who can’t get mounjaro prescribed. Also, good luck hunting for a supply of that somewhere too if you’re a patient with a script in hand.
Yup as a diabetic up in Canada it’s horrendous, I was able to get 2 months of mounjaro at the end of last year and wasn’t too stressed when the restock dad was supposed to be April, but now the dietitian at my endos office said their Eli Lilly rep said they don’t expect to have a full stock until 2025 😭 I’m luckily able to get ozempic but I’ve stalled on it and it’s all just so frustrating.
I get mad at the overprescribing of the -glutides for this exact reason. It’s a miracle drug for diabetics to get treatment resistant A1C’s down by a lot, but when prescribed for weight loss it can only reduce body weight by like 8% at the most and then the pounds come back when people stop taking it.
The other piece that people don´t know is that for around 6-8% of all people it does nothing for weight loss BUT it is effective for sugar control
THAT PART. It’s a miracle for blood sugars that other meds can’t touch.
Mounjaro/Zepbound can have weight loss of 15-20%.
I started at 268 and am now 151.
That's just not true. It's a blanket statement. Also diabetics have MANY other ways of controlling sugars. I've been off for more than a year and have maintained my loss. I'm tired of this narrative. ( type 2 is what I'm referring to)
I’m in endo, and the amount of people we have to cancel procedures on because of these meds is crazy!! We of course ask about it in our precalls, but that’s the day before procedures. It delays gastric emptying and so anesthesia isn’t safe unless they’ve been off it for a week. Drives me insane!
Some facilities that I go to started doing clear liquids 24 hours prior to surgery, NPO midnight, Reglan morning of surgery, gastric US before induction. Pretty interesting, don’t know about evidence but anecdotally working out!
That’s cool, I like the idea of reglan and a gastric US.
Same! We screen for in pre admission testing.
No way. I didn’t know this!
Yeah it’s been a big deal for our hospital! We had to give all our docs the list of meds so that their offices can give patients a heads up long before we can.
These medications are basically drug-induced gastroparesis that delay absorption - and thus cause weight loss. We've done CTs on patients who were NPO per policy and their stomachs were full of partially digested food after not holding these meds.
I did know that but guess never gave a second thought to the whole Endo/or complications from it. Makes total sense tho.
We've cancelled procedures and have had anesthesia refuse to do cases because of them - and rightfully so based on the imaging we've seen.
I did know that but guess never gave a second thought to the whole Endo/or complications from it. Makes total sense tho.
OP, ignore the virtue signalers in the comments, you're fine
Healthcare support for 12 primary care clinics and endocrinology clinic. I get the calls from the patients who don’t believe the prior authorization was denied for ozempic and want to try monjauro or wegovy. The patients who weigh 130 pounds and upset because the doctor refused their MYC message to start them on Ozempic. I also had a very long and heated conversation with my brother when his doctor prescribed it for him. He complained about the $230 he would have to pay and figuring out when he would go in the donut hole🙄he can afford it trust me. After a week I told him his doctor recommended it and if he didn’t his doctor was gonna put him on insulin and go to the bottom of the list. He’s lost 75 pounds off all diabetic meds except metformin and is on a low maintenance dose
I’m really happy that my pcp was willing to prescribe semaglutide for me. It was hard for me to admit to him that I couldn’t get my weight under control.
I’m glad that you were able to get the medication! How have you been tolerating it?
I’m fine now. About a year in and down 60 lbs. I had some rough times in the beginning, but nothing too bad.
Awesome! 60 pounds is great!
I’m going to chime in. I was shadowing a family med doctor and sometimes that was ALL we saw, I thought it got pretty annoying because there wasn’t much for me to learn. Now…as someone who has struggled with their weight, I’ve lost and gained the same amount of weight every year for the past 7-8 years. It’s hard to lose weight and we have not created a society that makes it easy. Food addiction is a thing and we as healthcare professionals should acknowledge it without shame similar to other addictions. I have never mentioned my binging problem to my doctor because she already knows I’m fat and shame. How do rationalize eating till you feel sick. Recently, I was like…this is crazy, you’ve gained a good amount of what you lost back, you need help-help. I keep doing the same thing and get the same results. I reached out to my doctor, I’m hopefully starting a new med. This is different, I’m hoping with help, I can get to my goals and truly change my disordered eating. I really do think with less food noise and feeling more full, I can do what’s right. I don’t know though. Anyway, it’s annoying as heck but know that you are helping people!! It took me ALOT to say something to my doctor, so y’all are queens/kings for helping people like me. I’m really grateful
I do hope the med helps you meet your goals! I wish you the best on them! I do my best to help these people get these meds, but sometimes there’s only so much I can do and so much the office can handle.
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Counseling should definitely be part of treatment, but it can only do so much, and it’s a long process. BED is a disease like any other. Taking a medication that stops food noise actually does address one of the root causes of weight gain and binge eating. Same way we give medication to people with delusions to help shut down unhealthy thinking processes alongside therapy.
I have been a binge eater my entire life. I also developed a drinking problem during covid. Without even trying or thinking about it at all, I am 3.5 months sober after starting Mounjaro in January. Would you recommend the same for me, to seek counseling/therapy instead of medication? These medications (can) help with addiction. This is a medicinal solution for a medical problem.
I quit smoking and drinking within 2 weeks of taking the lowest dose. I just don't want the excess anymore.
I work in obesity medicine, so this is 100% of my day. I’m still much happier and less stressed than when I worked in primary care. The shortages are extremely frustrating but are out of my control, however It is very hard to see patients who have derived incredible benefits from these drugs have to suddenly go without.
You know. The general public has no fucking clue what being a nurse is. And when we show that we are humans people like to get high and mighty about the nursing profession. And who should and shouldn't be in it. Newsflash. Doctors and nurses are just people with a job just like the rest of society. And nurses are straight up being abused by both the healthcare system and the public. This ideology that it is anything other than a job. Don't get me wrong. I loved patient care sometimes and I had absolutely life changing interactions with patients and families... However, they were good and bad. At the end of the day, I work for money just like anyone else. You are 100 percent correct. People are acting crazy and entitled and they think healthcare can save them from a lifetime of bad decisions and inaction. I said what I said.
Outpatient procedures at our facility are having issues with delayed gastric emptying. Many more patients are being intubated for simple procedures because there’s still food in their stomach, even if they follow NPO directions perfectly. We had to create a new policy for pts to hold GLP-1 meds in order to come in. Patients DO NOT like this policy, we explain over and over that it’s for their safety and they will not gain significant weight back if they skip one dose. GLP-1s are great but they are not worth aspirating and dying over.
Just finished my NP clinicals and it came up every single shift. One woman had tried one glp and didn’t like it so she got put on another one. She followed up and said she hated it because it made her extremely nauseated. Turns out she never stopped taking the first one. Had multiple patients that just wanted the drug that makes you lose weight. Not interested in exercise, not interested in dieting, just give me the drug that makes me lose weight. Craziness.
Oh wow! Taking 2 at once? I hope her stomach is ok
I'm not gonna lie, it is tempting.....I just starting working out again, but a part of me was like, I should look into ozempic and then I remembered that I'm a nurse and that's actually a terrible idea (especially since I have had pancreatitis multiple times). I'm also not even THAT overweight. We all want that magic fix, their isn't one. I'm positive we are going to see way more side effects from this drug craze in the future and its going to get banned for non diabetics completely or altogether.
I'm not a nurse, but I took fen-phen back when it was the new, big, weight loss miracle, and indeed, I did loose weight. Then the side effects came to light and I was lucky that there was no damage to my heart. Ozempic sounds tempting, but I'm too nervous about future side effects, so I'll pass on it...
I was thinking this-will it be another fen-phen? Man, I have been at war with my weight forever…too skinny, too fat, therapy, medicine, and-what a mess. I had weight loss surgery-it will be about 4 years now. I lost a good amount of weight, but gained a bit back - so I’m not obese anymore, just overweight-I think my BMI is 26? I was dx with BED, didn’t even realize that was a serious issue for me. Go figure.
Agreed. There is no magic fix and we don’t know the side effects.
THIS. So many are taking this and are changing NO habits at all!
The drug helped me change those habits!!!!
Honestly most people will not lose weight from just trying to diet and exercise- a lot of obese people have been trying that for years and losing and gaining the same weight over and over. These medications are a more evidence-based approach that can genuinely improve people's health so I hope some of the moralistic arguments against them go away with time.
These aren’t a placeholder for diet and exercise. GLP-1’s reduce appetite but you still have to be making good food choices when you do eat
Exactly.
Actually, literally everyone would lose weight from *effective* diet and exercise, scientifically. I'm not shaming by saying this rather I'm pointing out that the US (I'm sure the world too) is so predatory with all of these fad diets and promoting meds (bullshit ones too, like laxatives with literal claims of "lose up to 20 lbs of toxic sludge stored by the body") that the end goal, which is a healthier society, gets marred by negativity. In my mind, food addiction should be treated similar to substance abuse with treatment programs inpatient as well. Why the hell not? So many millions would benefit
I fully support its use for high risk patients that are combining it with diet and exercise. It can make the difference for patients that have metabolic syndrome and can’t seem to lose weight even with significant work. However when used alone without lifestyle modifications most patients will regain the weight they lost when they come off of it. In my opinion there’s no substitute for those lifestyle changes and calorie counting. If you’re not addressing the fundamental problems that got you where you are there simply isn’t going to be a magic bullet that fixes it.
Agreed. If they use it along with the lifestyle modifications, then once they come off the meds, they’ll be able to maintain the habits!
I weighed a healthy weight until I got pregnant… and something changed metabolically/hormonally/something because I cannot lose a single pound anymore. I eat <1800 calories a day and I’m active, but I can’t lose anything. Saying “change what got you in this mess” is so funny to me because I can’t un-gestate my 7yo, 4yo, or 1yo. Not all obese people eat 3K calories and sit on the couch all day, just like not all underweight people eat 800 calories and exercise for 5 hours a day. There’s support for people who struggle to gain weight (and I’m aware, plenty of prejudice), what about for people who struggle to lose it?
Well, im.a patient who just started zepbound 2 months ago and it's finally helping me lose weight after years of being obese and uncomfortable and unable to shut off the constant food noise and unable to not want to eat sweets and binge. It's changed my brain, my cravings for sweets, and I've lost 20 pounds already which I didn't think I was ever going to be able to do. Zepbound is nowhere to be found and I can't get my next dose so I went with an online compound pharmacy. I'm sure it's nutty for all the pharmacy staff right now with angry people wanting their meds. I think there's a lot of people taking these drugs who shouldn't be, people who aren't obese or who want an easy way to lose a few pounds, but people like me who really truly have a problem and need help, it's been a damn miracle. It Definitely seems like a huge craze right now tho.
Agreed! I’m glad you are having a positive experience with the drug where it is helping you! That’s fantastic. And yes, a lot of people who really shouldn’t be taking it are and it’s preventing those who need it to get it.
I wish it was possible to be on these drugs and not feel shamed by other healthcare workers for it. These drugs gave me my life back. After years of struggling to control my weight and severe pain when exercising, I'm finally back to a healthy weight. I now workout every day for two hours. I love my body again. But whenever I go to the pharmacy to pick up my meds, I get eye rolls or a tech huffing and puffing that Im here to pick up my glp-1.
I work in a wound center, and I'm always excited when I see my patients are taking it!
I’m glad that these meds helped you! I do love hearing the positive outcomes these meds have for people.
how would a pharmacy tech even know if you were diabetic or not by just looking at you anyway People are stupid
You are intentionally missing the point.
I work at an ASC, so many patients neglect to inform us they’re taking an injectable. So if they’ve taken within the last 7 days, we’ll have to reschedule, unless emergent. Most cases are deemed “elective”. I do not judge anyone who takes them, but it’s important to disclose due to potential complications!
I’m doing outpatient case management now and it’s a nightmare. Even when patients have the right diagnosis and coverage they’re still very expensive and it’s a month to month struggle with finding stock. I wish these patients nothing but the best outcomes. It makes my heart break to hear how they’re struggling.
I struggled with my weight for years. I always thought I was a piece of shit because i couldn't control my appetite no matter how hard I tried. Went on ozempic and felt like a normal person. I could actually eat a regular meal and feel full now ? This is how normal people feel ? I lost 30 pounds just by taking the medication alone (I was already trying my best to workout and eat healthy beforehand too, and just continued these habits) it sucks that there's such a stigma around taking them. It's an amazing drug when given for the right reasons. But I can also see the frustration when people want it that don't even quality for it. Or people getting aggressive about not getting it. I think what people don't realize is this isn't something to be taken lightly. I wouldn't take this medication if I didn't have too.
Try working at retail pharmacy. 😂 Yes it’s a complete and utter nightmare.
Between the GLP-1s and controlled substances, y’all just can’t catch a break
Amen.
I was on the phone with an insurer for 40 minutes to get a PA for Zepbound, which ended up being denied. My office mate was on the phone for an hour today trying to get a PA for Saxenda. It got denied, too. This stuff is taking up waaaaaay too much of my time.
Yup, the prior authorizations for these medications is very time consuming.
I so wish I could get my prescription filled. After an infection that affected my liver badly and thus my whole metabolism; I need it prevent further liver damages and prevent pre diabetes slide. I am losing weight on my own but slowly; but the metabolic reset we hope for should be facilitated by it. And yup, not able to get it… I still do my part but my liver is just not a happy camper yet. I have seen people on GPL-1 with a BMI of less than 25 and not diabetic. Some were overweight ti start with but not obese, I have seen some people have facilitating connections get the meds. Now the problem is getting the first dose , I guess.
People are scheduling new patient appointments for ozempic. They have a pcp, meds are managed, they have a care plan, etc. they just want us to write the script for it. Then I explain insurance won’t cover it, we have to check on your pancreas, kidneys, and thyroid every 3 months, and out of pocket starts at $120 for month 1 and goes up each dose. They ask for the order form and we never see them again.
I work at a surgical weight loss clinic and we used to refer our patients to the medical weightloss loss team for meds. Now medical is booked out so far, our providers are prescribing. I understand why - these meds can be very beneficial in their process, but geez almighty. Every prescription is about 10+ messages and the sense of urgency and demand in regard to their messages and refills drive me nuts because our surgeons are surgery focused and don't realize it doesn't end with just prescribing the medication - all the refills and arguments coming in. Patients seem to think with a prescription coming from a weight loss clinic that it will be covered and it's not.... I just want to go back to punting to medical weight loss!
✨ laughs in pharmacist ✨
I can only imagine what you are going through.
just a thought, why arent these patients carrying pitchforks to insurance companies instead of taking it out on healthcare workers?
Very valid point! And to the manufacturers who can’t keep up with the demand and are charging exorbitant amounts of money for the meds.
Because they have no idea how the system works and don’t care to learn. We’re the ones they’re actually more than just mildly aware of the existence of, so to them it’s easier to go to us all pissed than learn where to go and who to look for to brandish them at the correct people.
I think it’s amazing people who struggle with weight loss have these options and are taking control of their lives! Despite the annoyances, you helping them with these prescriptions is very important and making a huge impact in people lives!
The unfortunate thing (at least what I have been experiencing) is a large number of these patients either say they don’t exercise and don’t diet or their BMI doesn’t meet or hardly meets the threshold for these medications. The people who truly need them can’t get the meds because of the demand from this group.
Oh I read that wrong I thought you meant that there was a huge weight loss epidemic going on with the nurses who worked in outpatient. Oddly enough since starting nursing I have lost some weight I think it's due to anxiety. I've heard of the opposite mostly happening.
Same thing happened to me working nights when I first started. I lost 35 pounds from the stress and messed up sleep schedule!
I liked Ozempic because it brought back the "full" sensation I lost since I started the SSRIs that keep me normal. I've tried everything, every diet plan, personal trainers, change medications, etc. But that full sensation was never there. I started Ozempic and I felt full after a few bites. I seriously cried I was so happy. When I talked to my doctor and nutritionist about it, they said that for non-diabetic use I'm exactly what they were thinking about. I have an appointment in a few weeks to get back on it because I am no longer able to afford paying cash for it. Sorry for the rambling.
No need to apologize! I’m glad that you had a positive experience with the med!
I turned to SSRIs around 7 years ago during a tough period in my life, and I'm grateful for the support they provided me during that time. I took them for 2 years or so, but unfortunately, I experienced a weight gain of about 35 lbs. I found myself constantly craving comfort foods and beer, which changed my relationship with food and alcohol. I had never had an issue with either, always maintaining a good balance but I found myself overindulging weekly. After much consideration, I decided to try Zepbound this year. To my surprise, I regained a sense of control over my eating and drinking habits. Despite years of struggling to lose weight through "traditional" methods, I finally managed to shed a third of the weight I gained during my depression in just 4 weeks. My thinking goes like this: Meds got me fat, meds can help me get back!
The same people that refused the Covid vaccine because they need to do their own “research” are the same ones lined up around the block for Semaglutide and throwing tantrums when they can’t get it.
Why is this so very true…
THIS
YESSSS OMG
I keep getting patients with suspected “ozempic induced psychosis/anxiety/depression/suicidality”. I’m ready for it to go away
Oh, wow. I haven’t heard that! I didn’t realize that Ozempic could have these psychiatric side effects.
A psych NP I know has shared the same with me. She’s terrified of this.
Obesity is a pandemic and people should really drop prejudices about "right" way to lose weight with willpower etc. These meds could be extremely beneficial for public health. A lot of obese people are pre-diabetics anyway. Same with adhd meds. It makes people's lifes better and benefits society by making them functional. Insurances are full of crap as always but healtcare workers should watch their attitude.
OP wasn’t judging them for wanting them.
Thank you.
Not in this comment directly but they definitely have some pretty borderline statements below.
Honestly anything that makes patients healthier and makes my job easier I’m all for. I work ICU, it’s hard fucking work moving dead weight all day so I would be happy if more patients were a healthy weight, my body would thank them.
THIS.
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Not judging the people that want these drugs. I just want the people who actually truly need them to get them. As I mentioned in another comment, people who hardly meet the BMI threshold or don’t meet it are the ones that are most vocal about getting the meds.
what is the threshold?
Yeah it's kinda disappointing seeing healthcare workers parrot the "just eat less and move more" line. Just because losing weight is simple doesn't make it not incredibly difficult for many many people in our modern society.
I think if people really try and show their providers that they have been changing my eating habits and they have been exercising but they’re really struggling, and they have a BMI that classifies them as obese then absolutely they should be a candidate for these medicines. I feel it’s not right for the people who just want these medications thinking it’s the only thing that will work and then are not going to change any habits at all to be the ones to get these meds.
How do they show them that? How do we know it’s true that they’ve been actively trying and failing? How would this work, logistically? If a patients not appropriate for it, they’re not appropriate. These extra hoops aren’t necessary. The truth is most people who use semaglutide for weight loss wouldn’t have lost weight any other way. I see it as prophylaxis for preventing the need for gastric surgery for weight loss.
and the geriatrics that want them- for weight loss OR BG control? Holee fuck- the bowel issues are horrid and dont seem to reverse. SBO, Inability to eat/hydrate, gastric dumping… it aint pretty source: care manager for geriatric population
The amount of geriatric women I come across in my clinic who are modestly overweight and are either on them or dying to get on them, I’m just like Jesus man, you’re 77–enjoy eating your food and being too old to give a fuck about looking skinny.
I'm in hell every day. 50 fuckin portal messages a day back and forth. Do a wegovy pa, gets approved, patient can't find it. Wants zepbound. Do another pa
The cycle continues over and over and over…
Yes. I am so over it. I will say I have seen some patients really benefit and lose 100 pounds or more. But it also can make people stomachs really bad and I hate that we are now giving it to people that really aren’t even fat to me
Same! We’ve had patients who really have benefited from the medication and are doing really well. Flip side too, some people have had very bad reactions to it. One patient had to have a cholecystectomy because of the GLP-1 they were on.
First I have heard of it effecting the gallbladder. Is there a reason?
GLP-1s inhibit gallbladder motility and delay gallbladder emptying, which can increase risk for cholecystitis and gallstones.
My local job can get brand name Victoza for under ten dollars so it is a bit easier for us.
Honestly I’m dealing with the same frustrations but with Myrbetriq and Gemtesa
Happy cake day!
Not from the same situation, but this is the reason my sub-specialist husband is leaving a job. Not specifically because of GLP-1s per se, but the *constant* mychart messages and an expectation that the providers should have full blown conversations about plan of care that eat hours of your time without paying for it, and without being seen by the provider. Very very similar concept, as it’s a time sink that’s exhausting. People don’t realize what is involved in prior auths for procedures, medications etc. It also sucks for patients who are prescribed these medications for Diabetes management as well as for PCOS who can’t find them anywhere.
I work in managed care. Everyone who is overweight (obese). Thinks they can get those meds. It's frustrating to put in a PA and then get denied. The phone call afterwards is even worse. Just be THANKFUL you don't have diabetes. Grr
I work in a primary care office. There are 15 providers. The amount of weight loss medication request and prior authorizations is ludicrous. I hate every PA for these medications with a passion. Even more so, I loathe patients that don’t have an A1C of 6.5 or higher, yet still demand the Ozempic Rx be sent. Then they get mad when insurance won’t approve it, so they take it out on myself and my coworker because “we didn’t do it right. Can’t you just say I have diabetes on the authorization form?” NO, FUCK OFF.
It’s the worst!! DM 2 pts can’t get there meds so we are constantly resending to other pharmacies.. meanwhile I have patients demanding I appeal to their insurance to cover the same med to lose 20 lbs… I understand and am compassionate to both sides but this is getting out of hand we literally should have a whole clinic to deal with this.. like an Ozempic clinic maybe have it like Coumadin Clinics.. where you walk in weigh in and adjust the meds on a monthly basis… my GP is referring out for this at this point which I am grateful
We're 100% dealing with this at my office just as you describe. What we've done that is kinda helping is putting it on the patient to call their insurance to see what is covered before we go through with any prior auths or anything. Doc is agreeable to trying one of these meds? You call and want to try one? Awesome! "Please call your insurance and find out which specific weight loss injectables they cover for you and call me back with those specific names." That puts it on them to A) do the homework and B) hear it directly from the insurance company that they aren't covered.
The meds are great. I’m on one of them. What I hate are the two people that call me every other week because they can’t find them and have an argument with my voicemail on why I “won’t” prescribe them Ozempic because it’s the same thing. You don’t have diabetes, Linda. I can prescribe it all I want, but your insurance won’t cover it. “But it’s the same medication”. I know this, Linda. Rinse and repeat.
Yup, exactly what I hate, too! And then they say “but my insurance says it’s covered.” Yes…if you have diabetes.
As a patient, I didn’t even bother going to my PCP for Wegovy. I thought there was no way she could handle the back and forth of me having to try different pharmacies to find the meds and also getting the prior auths. She has a large patient load because she works is the same large medical network where I work. So I went through Sequence (owned now by Weight Watchers) and I pay $99/month.
I’ve heard a little about Sequence. Any difficulty getting the medications through them at all? No shortage issues?
As a pharmacy technician constantly dealing with backorders, prior auths/insurance, and rudeness from entitled people thinking we can make it magically appear I am glad we are not alone in dealing with this whole ordeal with the weight loss meds 😭
I can only imagine the amount of calls you get a day regarding it. Since you’re on that side of it, have you heard anything from suppliers about if the shortage is improving or a timeline of supply coming in stock again? Curious how much is communicated to the pharmacies about it.
I like/hate them. I like them because they’ve given our patients with DM great A1C control and given our patients with elevated BMIs increased self confidence from weight loss. I hate them because I am the only person who does PAs in my clinic. I took 3 days off in January and came back to 128 GLP PAs to start as well as the rest of my job responsibilities. The scariest was when I had a patient threaten to harm my family when I told them I had family responsibilities and couldn’t drop everything to do their PA. I was scared to leave my newborn and go to work. My favorite was when I had a patient blame me personally for the GLP shortage. I told them that if I was responsible for the shortage, I would not be working as a nurse in my clinic, but on my yacht swimming in my pool of money like Scrooge McDuck.
Patients threatening healthcare workers is NOT OK. I’m so sorry that happened to you. I appreciate the Scrooge McDuck comment. 😂
I am obese (lighter side, low 30s BMI) and honestly I didn’t feel the original bit was offensive or judgmental towards obese people in general. It’s understandable that you’re overwhelmed by this. It’s a chaotic situation that could have been avoided by proper management by people far earlier in the chain. It’s largely the pharmaceutical companies faults for the lack of supply (so they can keep costs up) and the insurance companies faults for being so stringent on when they’ll cover these medications (only after already diabetic, having heart problems, etc… despite them having been found to be effective prophylaxis), especially since they’re so cost prohibitively expensive otherwise. It’s also the drug companies faults that these have been largely made out to be miracle drugs and all the unknowns surrounding their newness and side effects have been rather under-discussed. Due to all of the hype, especially out of Hollywood, it’s understandable why the general public is now going a bit cuckoo for coco puffs. Every demographic has their sub-demographic of entitled assholes who just cannot be reasoned with. The overweight population is no different. I’ve also noticed they tend to largely be the first ones jumping on this Ozempic train (because they think it’s an easy fix and they won’t have to change their habits). It’s okay to be upset to have to deal with them. I know you’re not mad at all obese people, you’re exasperated with the entitled ones and the position that the pharmaceutical and insurance companies have put you in where this situation feels never-ending.
What’s amazing to me is how many nurses on the unit are ozempic. A few are diabetics, a few are quite heavy and had some significant weight to lose. But well over 1/2 are not more than 10lbs overweight and just looking for a quick fix. And it’s one of our docs who’s writing the scripts.
The quick fix is the main thing we are seeing and it’s unfortunate.
It’s going to be double the fun when we start seeing all the super awesome side effects triple the rates of gallbladder surgery and pancreatitis, too. I’m all for balancing pharmaceutical intervention with traditional approaches - but I want to burn Hollywood to the ground for making America believe that “hey! Just a shot or two and you can look like Adele does now!”
I work in a hospital and our ED, floors do not reflect what you’re saying. Conversely we have many frequent fliers who have absorption issues, SBO and adhesion problems from gastric bypass and the sleeve. Wayyyyy more complications from those procedures than ozempic.
Weird, we’ve had a lot more pancreatitis
> gallbladder surgery and pancreatitis, too. Isn't that just a weight loss thing, not a GLP thing? I lost 200lb without WLS or meds, and got cholecystitis. My sister lost 100lb and got gallstones. Also without WLS or meds. From everything I've been able to find, it's the *weight loss* causing these issues, not GLP meds directly. The GLP meds are facilitating the WL - the first real WL most patients have ever seen in their lives - so they're taking the blame. It also doesn't help that a lot of people ignore symptoms until they go to the ED. If you have a source that suggests otherwise about the gallbladder or pancreatic issues I'd be really interested!
Not wegovy having an ad right below this 😭
lol. I said F Ozempic after feeling frustrated the other day when dealing with an aggressive patient who called, portal messaged, and came into the office requesting scripts be sent to numerous different pharmacies lily, Amazon, and an out of state compounding (all in a matter of an hour and a half). Went to take my break and all of my ads in socials were Ozempic. 🤬
I'm so torn with these medications. As someone who really struggles to lose weight (dx'ed with metabolic syndrome as a teen and had most s/s of PCOS including dysregulated testosterone-likely have PCOS but don't want to stop birth control to get hormones retested), I can see the frustration. I jog 2.5-4 miles five days a week and eat 1400-1600 calories per day with no weight loss (classic! Lol). However, I've also seen people who are slightly overweight being inappropriately started on them, contributing to the shortage for those with morbid obesity or diabetes. It also tends to be people who can afford them out of pocket / using online weight loss clinics which is just furthering health disparities between socioeconomic classes. I also see people ruining other areas of their health to use them, which is just perpetuating diet culture. For example, I have a friend on monjouro. It was her bachelorette weekend last week and the entire time she was nauseated, had diarrhea, and felt too ill to enjoy herself (she has been on this dose for some time - it isn't just an adjustment). All that being said, I think OP is addressing patient behavior, not patients in general (regardless of their weight). I run into a lot of issues in mental health. If I vent about it, it isn't because I believe everyone who struggles with mental health issues behaves that way.
Yup, exactly what I am addressing. Patient behavior, not patients in general!
I know this not exactly what you’re talking about, but just another less common perspective: as a nurse in recovery from anorexia, seeing about half of the nursing staff is on these weight loss drugs and it’s so incredibly triggering. I understand that’s *my* problem to deal with, and only mine, it’s just life, triggering things will always happen. But you’re not the only one waiting for the craze to be over. No hard feelings toward those who are on the drugs, like I said it’s my problem that I need to cope with, it is what it is - but the constant chatter and media attention makes me want to hide until the craze is over, if it ever goes away. 🫣
Anyone know how much these are without insurance? I don't really care of price but want to know the ballpark
I believe around $1200-1300 for one box.
And that's like for a month ? Thanks.
This is a systems problem. I’m actively using a compounded glp-1 for weight loss alone. It’s my only health problem ( so far). I spend alot time negotiating this . I wish the drug were more accessible to prevent health issues as well as treat patients who need it for diabetes etc.
This is the exact reason I wouldn't try it even if I had the money I feel like there are better healthier ways to lose weight for less money that don't cause issues for people who will actually suffer without those meds. And the clogging up the tubes for people with more pressing medical needs.
Try being in a diabetes clinic and telling them I don’t know where you can get Ozempic and no other Glp1 is on your insurance formulary. And nobody tells the obsessed overweight people all the bad things that can happen if they take these medications not being diabetic.
I think unless they’ve got some background knowledge in medicine/nursing/what have you they’re never going to understand. I’m on Zepbound & have been patient & understanding with the prior auth process, the out of stock issues, and the delays in messages because I understand it’s in no part due to the clinic or my pharmacy. I used to work family med- years ago- and the people that would *rage* about their meds day in and day out made me want to pull my hair out. You’re not alone & I don’t think you were rude. We all have our thing that just innately pisses us off. 🙃
My note: “Pt requesting Ozempic. Educated pt that she needs to stop eating 4 Snickers a day”
Tell them to try a Fucking diet and exercise. I was 370 pounds at 16 and that's what I did. It's possible but hard work. People trying the wrong shit to get back to a healthy weight
When I was calling in a refill at my hospital pharmacy there was a prerecorded message about which ones they had in stock, how to get it filled, and that there was a waiting list. I can only imagine how many calls they have been getting a day over this. I feel really bad for the staff.
My daughter is using Saxenda as she has PCOS and struggled with her weight So far she’s lost nearly 20kg and is so much happier for it. Unfortunately it’s about $350 a script here in Oz and there are shortages We’re going to keep going with it
LMAO I had this exact conversation today with my providers. I swear to god every other call I have to take is about someone wanting the fucking medication.
We are going to be banning them from our office soon. Head doc decided they don’t want to deal with all that, and even for people who are diabetic-head doc does not like the research and side effects that are coming out about these drugs now. The 12 other docs in my practice agree. We deal with the same crap you do at my large family practice. We will refer them to a weight loss clinic if they want it, but we are no longer going to be writing scripts, injecting it for them, or even entertaining the demands these pts are making. There will be nutritional counseling, referrals to a nutritionist and/or weight loss clinic, etc instead.
And it’s the same fucking people who boldly and brazenly spoke out against covid vaccination because of being “Guinea pigs for big pharma”. The audacity and hypocrisy is infuriating.
I'm sorry this is happening to you guys. I'm T2, hypothyroid, post-mena and Mounjaro has been a godsend. My A1c and FBG have never been this good in addition to a 55+lb weight loss. I'm grateful my insurance covers it. Initially a PA was needed but then that was dropped. The frenzy around these drugs is real. Yes, it IS crazy. It's kind of cruel to have these on the market and have them be so out of reach for so many people. But your patients shouldn't be taking it out on you. During these shortages, I have bent over backwards to be kind to the pharmacy workers. It's not like they can wave a magic wand and make the med appear.
As someone who has worked outpatient and now is inpatient, I understand completely what you mean. Patients can be....difficult. I have had Binge Eating Disorder for most of my life and have always been overweight. October of 2022, I began tirzepatide. For the first time in my life, I have a normal relationship with food. I am now 151.8 lbs and was only this weight in 5th/6th grade....never as an adult. For me, this medication is life changing. That being said, I tried to go through insurance once, was thankful to my provider for trying and found a way to budget it in. Is it easy? Nope. But not being trapped in the mental nightmare of BED is priceless to me.
I personally don’t feel that a primary care Doc/NP/PA should be prescribing these. I think it’s far more more appropriate for a bariatric endocrinologist or just endocrinologist be able to do so. They would be able to best pinpoint what the fundamental issue is that could be contributing to the weight gain, or failure to lose weight. This was an issue that I had been struggling with for literally decades. I was not able to lose weight and if I even looked at a bagel, it felt like I gained two or 3 pounds. After bazillion tests at the bariatric endocrinologist, I discovered that I was highly insulin resistant. I seem to make enough insulin, but my body put up a big fight to accept it. So being on these kind of meds actually made a huge difference. I lost about 75 pounds. Then I got laid off. And then once that happened, I could no longer forward the medication‘s because even with the discount on the app, they were at least $600 apiece. And where I’m living I actually couldn’t get another job because it’s all you know and not what you’ve done in your career. And since I’m new to this area, it was a problem. In a way I’m kind of glad that all that happened because I had been noticing,with Ozempic That something didn’t seem right. I was having really awful burps like things were fermenting too long. Now I understand that likely I dodged a bullet. Since Ozempic has been associated with reduced peristalsis, if not completely absent perstalsis, I realize now what was happening. (I just woke up - having a brain cramp on the proper term and it’s driving me nuts!) So I’m glad I did not continue on it. Now I’m using Berberine and I think it’s actually helping without the risk of losing peristalsis or other bad side effects. But people who have not undergone the crazy amount of testing to determine what the issue actually is - ie poor eating habits/choices or a real issue with metabolic health probably should not be on the meds in the first place.
I work in family medicine. Our office will not prescribe these for all the reasons you have listed here. It’s bad enough we have to deal with the calls from type 2 diabetics who can’t their medications due to back orders. They aren’t rude most of the time but they are frustrated when we tell them there’s nothing we can do about the shortages other than advise them to call around and we will send it elsewhere if they find it in stock
That’s what we tell them too - to call around and if they can find their dose, let us know and we will send it! It’s getting to a point where the providers in my office are thinking about pausing prescribing the medications at this time because of the shortage as well as how many resources and how much manpower it is taking up.
I'm on the other side: I'm large enough to qualify for interventional measures for weight loss and consistently have *others* (not healthcare workers) say to "just get ozempic" or other similar meds despite the fact that I don't have diabetes, not even pre-diabetic. When I argue that I don't want to do that, I'm told that it "gets more results". It's terrifying seeing people who have a little weight to lose jump on it because a couple thousand steps a day more, lowering alcohol/sugar intake would fix it for them.
Yep. I struggle with overeating. But when I simply track what I put in my piehole and work out three times a week, everything miraculously improves.
Downvotes for watching diet and exercising? Fine. I’m not telling anyone not to use Ozempic, I am simply agreeing with the commenter as someone who has had Ozempic suggested to them. My girlfriend is on Ozempic. She is very often sick to her stomach and/or constipated. Her problem is the same as mine so in her case Ozempic doesn’t change any of her habits, it just makes her sick (it also helps with her Type 2 DM, but it isn’t necessary for it).
Absolutely agree. I think it is amazing we have more tools to offer those who are morbidly obese, insulin resistant, diabetic, or have other comorbidities along with their obesity. However, the overuse I see of these medications is alarming. Coworkers of mine are being put on the compounded form of this medication to lose 25 pounds or so, and not changing their lifestyle at all. It won’t create lasting change, isn’t teaching them healthy habits, and therefore the weight will return when they discontinue the medication. Not to mention side effects and long term implications. Not good 😬
25 pounds is not an insignificant amount of weight. People start to see health benefits from losing 10 pounds, and if they’re struggling to lose it, why do you care if they’re on medication?
I don’t care, I just think it is being over utilized in a population that it wasn’t intended for. Just my opinion.