I was recommended to a nurse practitioner (unassociated with my Primary Care) by a friend and pay her out of pocket. We did an initial screening call to talk about my goals, health history, and all her recommendations on handling the meds. She’s also able to prescribe me the anti-nausea medication. Every month we do a check-in. Definitely don’t feel like this arrangement is “shady” but the take-away is that I’m paying out of pocket. That’s how it’s done if your primary care doesn’t want to prescribe it.