November 2024
Once my PCP prescribed Zepbound, the challenge began: convincing insurance to pay for it or getting it filled while paying myself.
For background, I work for a large company and think I have pretty decent health insurance (administered by United Healthcare). My pharmacy called me to tell me that the insurance rejected the prescription. We tried filing a Prior Authorization, but that was also promptly rejected. After some digging, it became clear that my insurance has an exception to NOT cover GLP-1 agonists for obesity.
I was willing and able to pay for it myself (via a program run by Eli Lilly, Zepbound’s manufacturer). Even getting that prescription sent was a hassle. It needs to go to a special “pharmacy”, which was not supported in my doctor’s electronic health record system. Anyway, after 2 weeks, we had figured it out, and I received my first vials of Zepbound. The 2.5mg starter dose was $349 (for a 4-week supply). All the other doses are $499. It’s slightly weird that 4*5mg costs the same as 4*15mg, but I was glad to finally have it in hand.
I had very limited side effects (some constipation) and found Zepbound amazingly useful to reduce appetite and give me the willpower to stick to my calorie goals. Starting with 5mg, I would stay on the same dosage until I felt the appetite suppression decrease and then titrate up. I weighed myself every morning on a smart scale and monitored the trend in the HappyScale app.
I stayed on this till January, when surprisingly my insurance changed their rules. They introduced a new program where you sign up for a “weight loss coaching program” and then they might cover Zepbound. I had a couple of calls with a dietitian (who basically tried to explain what macros are) and clicked through a bunch of online modules but then was able to get Zepbound pens for free (well, $25 co-pay). For a while I had to have a call a month but at some point the dietitian said it was optional. At this stage he didn’t really teach me much anyway.
After a few months, I switched to Macrofactor for calorie tracking but otherwise stayed the course. I didn’t really have any real cheat days, and this included a week-long family vacation at an all-inclusive resort in Mexico! I did have some days where I felt hungry at the end of the day, but overall, I didn’t find it hard to stick to the new diet.
In the year I have been on Zepbound, I have titrated up to 10mg and lost 120 lbs so far.
Next up: starting an exercise routine.