GLP-1 medications available online

Your doctor will order labs for you before prescribing GLP-1 medications. These labs include an obesity lab panel, which measures CBC (blood count), CMP (metabolic function), lipids (cholesterol levels), A1C (diabetes), TSH (thyroid function), and insulin. Your doctor will then review the lab results with you to see if you would benefit from treatment with GLP-1s.

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 1-888-729-0438 or by emailing [email protected]. 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 1-888-729-0438. 

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 or Tirzepatide (in certain states).  Submitting an appeal rarely changes the outcome unless important information was not included in your original PA.

Most GLP-1s are injectable medications taken using a pre-filled pen, making it easy to inject yourself. Just like you would inject insulin, you inject GLP-1s into the fat layer, just under the skin. The most common injection sites are the lower abdomen or the front thighs. Rybelsus is an oral GLP-1 medication. It is taken once daily as a pill on an empty stomach, with no more than half a cup of water. Always consult your doctor for personalized medical advice. 

Currently, there is a high demand for weight loss medications in the U.S., causing a shortage of Saxenda and Wegovy, the only two GLP-1s currently approved for weight loss (as of September 2023). The Saxenda shortage is expected to last at least until the end of 2023. The Wegovy shortage affects starter doses and is expected to last into 2024. It is not possible to start taking Wegovy at a higher dose. If you are taking Wegovy or Saxenda and would like to continue the medication, we recommend calling local or mail-order pharmacies to see if they have your dose available.

Read more about the Wegovy shortage and alternative medication options.

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

Because GLP-1s target the root causes of weight gain, many patients experience sustained weight loss after stopping the medication. However, GLP-1s work best with a healthy diet and exercise plan. Individuals have a higher risk of gaining the weight back if they do not keep up with the healthy lifestyle changes they made.