Welcome to your weight management program with PlushCare!

The cost of these labs may differ depending on your insurance coverage. Some insurance plans cover the cost of these labs and some may not. If you elect to pay cash, your insurance for the labs, PlushCare has a discounted cash rate option with Quest Diagnostics and basic weight management labs are $105.  

If you are interested in the discounted cash rate option (i.e. not going through your insurance), please let your physician know that you want to do the discounted cash rate option before they order your labs as you will need to obtain a prepaid lab slip prior to going to the Quest Diagnostics. 

All of the lab tests we order through our system default to Quest Laboratory Services. If you need to complete your labs elsewhere, contact our Care Team, and they will send you a signed copy of our lab request to take to any lab. We also have another convenient option, where patients can get their labs done with an at home lab test kit as well. More information regarding at home lab tests are below under At Home Lab Testing. 

Results may take up to 3-5 business days. If you have done your labs and have not heard from us within 5 days, please email or call us to let us know your labs have been done. 

PlushCare offers AST, ALT, Serum Creatinine, Insulin, TSH, Lipid, HbA1C at-home lab testing kits.

Our at-home lab tests are available to patients in all 50 states.

This lab set costs $109 and will be billed to your payment information on file.

It can take approximately 3-5 business days to ship.

It can take approximately 5 business days to process.

Yes, we are in network with most major insurance providers. 

However, most insurance companies require a prior authorization to be submitted before they will respond with the cost of the medication for you. When your PlushCare physician prescribes the medication, our care team will reach out to your insurer on your behalf. This process can take several business days. Your insurance company typically responds within 1-2 weeks with their decision about medication coverage. If your insurance company denies medication coverage or if you do not have health insurance, you may still purchase the medication at the cash price. 

Insurance companies often require Prior Authorizations (PAs) to cover the high cost of FDA approved weight loss medications such as Saxenda (liraglutide), Wegovy (semaglutide), or Zepbound (tirzepetide). To be as efficient as possible, we submit most requests electronically via Cover My Med.

The information we need to submit your prior authorization is collected during your doctor visit, by getting your lab work done, and by entering your insurance information before your second visit.

The PA process starts automatically once your doctor prescribes medications to treat weight loss or type 2 diabetes. You will receive a confirmation email that your information was received and in the queue. It usually takes 3-7 business days for our team to compile the necessary information to submit your PA, but this can vary. If we need more information from you, our care team will reach out via email.  Please make sure that you check your email regularly, including your spam folder. The process can be delayed if we do not have all the information that we need to submit a complete PA. If you were prescribed a medication that needs a PA and you did not receive a confirmation email from us or if you have a chance in your insurance information, please reach contact our care team at info@plushcare.com.

If you’ve been prescribed a different type of medication and your pharmacy has told you a PA is needed to process the prescription, please call us at (888) 729-0438 or email at info@plushcare.com. You may be asked to fill out a short intake form with information about your insurance and prescription history.

You’ll need to provide us with the following information:

• Name on file with your insurance company

• Address on file with your insurance company

• Rx number

• BIN number

• PCN number

• Insurance identification number

The information you provide must match what your insurance provider has on file. If the information doesn't match, it can lead to medication denials and delays in receiving your medication. Contact your insurance before filling the PA form if needed. 

If applicable, please include past medication details, relevant lab results and for weight loss medication, you can provide documentation from previous programs. 

These are often listed on your insurance card. If you can't find them there, please log into your health plan website or contact them directly for assistance.

Read more about what to do if your PA has not been submitted. 

When checking your insurance coverage for GLP-1 medications, it's important to ask specific questions to get clear and accurate information. Many PBMs do not disclose details unless prompted, so being prepared can help you avoid unexpected denials or costs. 

Coverage & Cost 

• Does my plan cover [medication name] for weight loss? (e.g., Wegovy, Zepbound) 

• If not, does it cover any GLP-1 medications for weight management? 

• What is my copay or out-of-pocket cost for this medication? 

• Are there any manufacturer savings programs or discounts available? 

Prior Authorization (PA) Requirements 

• Does this medication require prior authorization? 

• What medical criteria must be met for approval? 

• Are there specific lab tests or medical conditions required? 

• What documentation does my doctor need to submit? 

Step Therapy & Alternatives 

• Does my plan require step therapy, meaning I must try other medications first? 

• If so, which medications must I try before qualifying for GLP-1 coverage? 

• How long must I try alternative medications before requesting approval? 

Weight Loss Program Requirements 

• Do I need to complete a structured weight loss program before approval? 

• If so, which programs are accepted? (e.g., Omada, in-person weight management programs) 

• What proof or documentation is required for program completion? 

If your prior authorization is denied, please find out the reason for the denial. In your follow-up visit with your physician, you can discuss other treatment options. 

The four most common reasons why medications are denied:

1. Insurance plan exclusion of all weight loss medications:  
This means your insurance plan does not cover any weight loss medications or GLP-1 agonist medications.  

2. No history of type 2 diabetes:
Most insurance companies do not cover FDA-approved for diabetes medications (Victoza, Ozempic®, or Mounjaro® to be used "off label" for weight loss. These same medications are also FDA approved for weight loss but have different names (Saxenda, Wegovy, and Zepbound).  If you have not done so already, the next step is to find out if your insurance covers these FDA approved weight loss medications.  

3. Non-formulary:
This means that you need to try several medications listed on your insurance company's formulary for your medical conditions during a period of time (often 6 months) with documentation they have not worked for you. Your insurance company will not cover a medication that is not on their formulary. 

4. Additional information:  
This can mean that your insurance company requires more information, Your insurance company may require an additional specialized test or your insurance company requires proof of a comprehensive diet and exercise program enrollment for a set amount of time (often 6 months) before they will cover a medication. There are other possibilities as well.  You should email any needed documentation to info@plushcare.com. 

This medication is started at the lowest possible dose. The medication dose is slowly increased with the guidance of your physician to the lowest dose that is most effective for weight loss. 

DO NOT increase the dose of medication on your own or start at higher doses than what was recommended. Please read the package instructions and/or go to the company website for a video on how to give the injections.

The medication remains safe and effective even if the ice melts during transit. As temperatures rise, it is common for ice packs to melt during the shipping process. The purpose of the ice pack is to maintain a stable environment inside the box. Upon receiving your medication, please store it in the refrigerator as recommended. 

For any issues regarding medication administration issues (i.e. what happens if the medication is stored improperly, vial or pen malfunction, etc., please reach out to your pharmacist and/or the manufacturer (Novo Nordisk, Eli Lilly).

Common side effects most commonly include feeling full easily, upset stomach, acid reflux, nausea, vomiting (especially with eating too much), burping, gas, constipation, diarrhea, headache, fatigue, and depression. It is very important to stay hydrated while on these medications because dehydration can cause kidney damage. Side effects may disappear during treatment as your body adjusts. You should never have abdominal pain, vomiting and inability to hydrate, or dark urine while on these medications.  You should never feel depressed or have thoughts of wanting to hurt yourself.

If you experience any serious side effects, such as allergic reactions, abdominal pain, inability to stay hydrated, depression and thoughts of not wanting to be alive please seek emergency medical attention right away by calling 911.

GLP-1 medications can slow the digestive process and can cause a feeling of fullness and nausea. If you think you feel full, stop eating instead of taking another bite. Avoid high fat foods as they digest slowly.

• If you feel full and nauseated: 

  • Try eating smaller meals. If you think you feel full,stop eating instead of taking another bite. Avoid high fat foods as they digest slowly.

  • Eat small portions of lean protein throughout the day like chicken or turkey and high fiber carbohydrates such as vegetables

  • Sip on broth or clear soups.

  • Sit up after you eat for 30 min to one hour. Don’t immediately lie down after eating.

• If you have acid reflux and bloating: 

  • These symptoms will often improve with antacids like famotidine or omeprazole taken 30 min before eating. Avoid TUMS as that can worsen constipation. If these symptoms persist for longer than 2 weeks or are worsening please see your doctor.

• If you have constipation:

  • Fiber supplements, a high-fiber diet, hydration, and daily activity can help avoid constipation. You develop constipation, take Miralax and/or senna once daily as needed to have a daily bowel movement.

• Although rare, GLP-1s can lower your blood sugar:

  • Symptoms of low blood sugar can include lightheadedness, fatigue, sweating, feeling weak, shaky, rapid heartbeat, or headaches. If you have low blood sugar, keep 15g of a sugar replacement on you (e.g. 1/2 cup of juice, 1 tablespoon of sugar, or 8 hard candies). If symptoms do not improve or worsen, repeat and seek medical attention. Do not drive if you have low blood sugar or symptoms of low blood sugar.

If you have symptoms of low blood sugar or documented low blood sugar, raise it by following the 15-15 rule. Take 15g of carbs (e.g. 1/2 cup of juice, 1 tablespoon of sugar, or 8 hard candies) and recheck your blood sugar in 15 minutes.

If your symptoms have not improved or your blood sugar has risen, repeat the 15g of carbs and seek medical care. DO NOT drive or operate machinery if your blood sugar is low or you have symptoms of low blood sugar. It’s important to talk to your doctor and let them know that you are having low blood sugars.

• Avoid Fatty/greasy foods if you have nausea

• Avoiding alcoholic beverages

• Avoiding caffeine, acidic foods, and spicy foods

• Avoid dairy products if you are lactose sensitive

• Avoid diet drinks/sugarless gum/candies containing sweeteners (e.g. sorbitol, mannitol, and xylitol), fructose, and sometime fruits (apples, peaches, pears) can make GI symptoms worse

Please stop the medication and follow up with your doctor or seek immediate medical care if you experience any of the following:

• Fever

• Abdominal pain of any kind

• Nausea lasting more than 48 hours

• Vomiting or diarrhea with dark urine, light-headedness, or dehydration

• Dark urine and not able to hydrate

• Thyroid tenderness or pain

• Depression or suicidal thinking

• Allergic reaction

Liraglutide (Victoza® or Saxenda®) requires 32 gauge pen needles. These are available over the counter and, like other over the counter medications, not always covered by insurance. Sometimes a prescription is helpful to cover the cost. 

Wegovy®, Ozempic®, Zepbound ®, and Mounjaro® are pens that come with their own needles.  Zepbound® vials offered at a discount through LillyDirect come in vials with needles and syringes. 

After administering, discard the needle in a sharps container. If you don't have a sharps container, you can use a hard-sided container with a lid, such as a hard-sided detergent bottle. Ensure the container is well sealed before disposal. For your safety, be sure your disposal container is no more than 2/3 full at all times. Once you are ready to dispose of your sharps container, please take it to your local sharps container disposal center.

Safe Needle Disposal is a great resource to help find a sharps container disposal center around you.

Sudden changes in blood pressure and blood sugar are common when people lose weight or take medications for weight loss.

Please monitor your blood sugar/blood pressure and talk to your doctor if you experience any of the following:

• Unusual fatigue

• Weakness

• Lightheadedness (especially when standing up)

• Dizziness

• Nausea

• Difficulty concentrating

The 15-15 Rule: 
If you have symptoms of low blood sugar or documented low blood sugar, take 15g of carbs (e.g. 1/2 cup of juice, 1 tablespoon of sugar, or 8 hard candies) and recheck your blood sugar in 15 minutes.  

If your symptoms have not improved or your blood sugar has risen, repeat the 15g of carbs and seek medical care.  DO NOT drive or operate machinery if your blood sugar is low or you have symptoms of low blood sugar. It’s important to talk to your doctor and let them know that you are having low blood sugars.