When Insurance Gets in the Way of GLP-1's

I was lucky when I first started a GLP-1; I had great company insurance benefits. Many people have to take finances into consideration when they decide whether to start this treatment. For me, that factor didn’t come into play until three years later.

My company downsized during the pandemic, and I found myself retired sooner than planned. I stayed on my company insurance through COBRA as long as possible but eventually found myself using the Affordable Care Act (ACA). The ACA was a lifesaver, but it did not cover my GLP-1. I knew the two years until I reached Medicare age were going to be financially difficult. A cancer diagnosis and major surgery had slowed down my weight loss progress but I was back on track. I simply was not going to jeopardize that.

Why managing obesity was a medical necessity for me

My family has a significant cardiac history, and managing my obesity was key to keeping me out of the heart attack cycle my dad, uncle, and all three of my siblings were in. When I talked to my doctor about my lack of insurance coverage, she laid out my options. She explained that her office would not prescribe a compounded GLP-1 because they were not FDA approved.

At that time, many pharmaceutical financial assistance programs and direct purchase websites were not available. It was almost impossible to access a GLP-1 without insurance. So, I had to embark on a journey to educate myself on managing the GLP-1 out-of-pocket cost. It became a part-time job for the first six months.

The mental toll of the "pharmacy hunt"

My husband and I decided that the cost of the medication was a necessary expense. I did not want to move to a compounded product. I trust my doctor, and switching would have meant finding a new provider. Furthermore, I always want an FDA-approved medication with research, testing, and data behind it.

I was angry and frustrated with our healthcare system. There was a shortage of all GLP-1s, so every single month, I’d have to research which pharmacy had stock. It was mentally exhausting. Some pharmacies would list medications on their websites, allow you to order them, and then issue a delivery delay. It was frustrating, but it was also scary. The thought of going without my medication made my anxiety unbearable because I was doing so well for the first time in my life.

Hard work beyond the injection

I was working really hard on my weight loss. Unlike what people who’ve never taken a GLP-1 think, it isn’t a magic pill. There’s a lot of hard work that goes with it, and I was simultaneously recovering from bladder removal surgery. My medical team was fabulous and would quickly get me a prescription for whichever medication was in stock in the same type and dosage.

Even when the only thing available was injectable Mounjaro with an actual needle and a vial, it was worth it. My nurse practitioner did a Zoom call with me to teach me how to self-inject. Thank goodness it was weekly, not daily! My brother was an RN, and for the first six weeks, he would get on the phone with me every time I had to inject with that darn needle and talk me through it! I hate needles, but I wasn’t happy but I was willing to do whatever I had to do to continue being successful. This was the first thing that worked for me in my entire 60+ year adult life. I managed this chaos for two years.

The Medicare "miracle" and Zepbound approval

Then I enrolled in Medicare. I was looking forward to the simpler process but knew that, at the time, Medicare didn’t cover these medications for weight loss. Then, what felt like a miracle happened! My doctor reached out to let me know that Eli Lilly received approval for Zepbound for sleep apnea, and Medicare would pay for it.

I was moved to Zepbound. I was surprised and elated! I already knew I could say goodbye to the monthly mental gymnastics, but to be able to consistently access my treatment and have insurance coverage—wow! It felt like Christmas had come early! The relief was physically palpable. For me, this is one of the benefits of having a fabulous medical team supporting my obesity journey.

Investing time in your obesity journey

There are more options out there now for navigating the GLP-1 out-of-pocket cost. Take the time to do some research to find out what works best for you. Putting in the time upfront to educate myself—whether on medications, or anything else for my obesity recovery, has always been an investment that has paid off in the long run for me. And while this was a lot of work, I got through a tough time without a break in medication. For that, I will always be grateful!

Editor's Note: Insurance coverages/approvals are constantly changing so please check with your insurer on what is covered.