GLP-1 medications available online

Most GLP-1 side effects are associated with mild abdominal discomfort. Common side effects may include:

• Nausea

• Vomiting

• Diarrhea

• Lower appetite

• Early feelings of fullness

GLP-1 drugs for weight management and blood sugar control may lead to low blood sugar levels (hypoglycemia). For this reason, it is essential to monitor your blood sugar levels.

GLP-1 receptor agonists can have several drug interactions, so tell your doctor about any medications, including over-the-counter drugs and supplements, before starting these medications.

• Other diabetes drugs used for blood sugar control, such as Jardiance

• Other weight loss medications

• Lasix (furosemide)

• Medicines for high blood pressure

As most GLP-1s require prior authorization for insurance coverage, it is likely you will need it.

Most GLP-1a weight loss and type diabetes medications require a prior authorization (PA) from the insurance provider:

• FDA-approved weight loss medications: Contrave®, Saxenda® (liraglutide), Wegovy® (semaglutide) Zepbound™ (tirzepatide) 

• FDA-approved Diabetes medications: Rybelsis®, Victoza® (liraglutide), Ozempic® (semaglutide), or Mounjaro® (tirzepatide)

• If your insurance company says that they cover FDA-approved diabetes medications, it suggests coverage for patients with type 2 diabetes. Insurance companies typically do not cover OFF LABEL prescribing of FDA approved for type 2 diabetes for weight loss without a type 2 diabetes diagnosis. It is encouraged to discuss with your doctor the possibility of prescribing an equivalent and/or similar medication approved for weight loss by the FDA. 

If you’ve been prescribed an injectable medication for weight loss or type 2 diabetes, our team will automatically start compiling the necessary information. This usually takes 3-7 business days but can vary. If you’ve been prescribed a different type of medication and your pharmacy has told you a PA is needed, you can let us know by calling 1(800) 221-5140 or by emailing info@plushcare.com. You may be asked to fill out a short intake form with information about your insurance and prescription history. 

Once your PA is submitted, you’ll receive an email titled “PRIOR AUTH SUBMISSION”. Your insurance will now review the documentation provided and issue a determination. Processing times vary, but the average is 7-14 days. We’ll notify you once we receive an outcome. If you have any questions during this time, you can reach the Prior Authorizations team directly by responding to the message titled “PRIOR AUTH SUBMISSION” or contact your pharmacy benefit plan directly. Please make sure you call your pharmacy benefit manager (PBM) as they will handle the prior authorization for your prescription and not your medical insurance network. The contact information for your PBM should be on your insurance card but may be on a separate card- common PBMs are ExpressScripts, CVS Caremark, and OptumRx. 

If you have contacted your PBM and they do not have your prior authorization on file, even though you received communication from us confirming its submission please give us a call at 1(800) 221-5140

If your prior authorization is denied, the cost of your GLP-1 will not be covered by your insurance, it is important to understand the denial reason.  Common denial reasons are plan exclusion for weight loss medications, non-formulary for your medication, or need for prior diet and exercise program.  You can discuss the reason for denial at your follow-up appointment with your doctor so they can help you discuss alternatives. Some alternatives include paying cash for medications such as Contrave® or Compounded Semaglutide.  Submitting an appeal rarely changes the outcome unless important information was not included in your original PA. 

As a PlushCare member, you can use our in-app Rx price finder to find the pharmacy nearest you with the lowest cost for your medication. With our Prescription Discount Card, available in-app, patients have saved from 7-20% on GLP-1 medications.

If your insurance does not cover these medications, or you are planning on paying out of pocket and need help covering the cost of your medication, it's worth also checking the manufacturer's website for coupons that may save you money on  Ozempic, Wegovy, or Mounjaro. It is important to acknowledge that these companies have eligibility and restrictions requirements for these coupons, and reviewing the criteria on their website is recommended to see if you qualify.*

• For example, the Wegovy coupon on Novo Nordisk’s site may help you save up to $500 off of the full price of ~$1500 for a month's supply. 

• For patients with type 2 diabetes, the Ozempic coupon on Novo Nordisk’s site may help you save up to $150 per month off the full price of ~$1000 for a month’s supply

• For patients with type 2 diabetes, there is a coupon on Eli Lilly’s website for Mounjaro to help cover the out-of-pocket cost of roughly ~$1100 for a month’s supply. Keep in mind that your pharmacy will likely need to see proof of type 2 diabetes for the savings coupons from Eli Lilly or Novo Nordisk for Mounjaro or Ozempic through a diagnosis code associated with the medication order before they can apply the coupon. Prescriptions cannot be written for a diagnosis of type 2 diabetes if a patient does not have a confirmed diagnosis of type 2 diabetes.

*Please note that the manufacturer’s coupons cannot be used in combination with the savings from our Prescription Discount Card. You can check with your pharmacy to determine which card or coupon will offer you the most savings.

Talk to your doctor before taking GLP-1 medications if you have any of the following conditions:

• A personal or family history of medullary thyroid cancer or acute pancreatitis

• Type 1 diabetes mellitus

• Pregnant, planning to become pregnant in the next 3 months, or nursing

• Delivered a baby within the past 6 months

• Ongoing heavy alcohol use

• Active eating disorder, anorexia, or purging.

• History of suicidal thinking

• Non-medullary thyroid cancer

• A family history of multiple endocrine neoplasia type 2