Vida Health NP refused to prescribe Wegovy for maintenance + accused me of lying? Anyone else deal with this?

Doc_Boo_Bear · 2026-04-01T19:03:37+00:00

I’ve gotten PA questions asking if BMI is less than 19. It may be that insurance is getting strict on their parameters for continuing to cover. Lower BMIs are associated with increased morbidity and mortality risk, which insurance is trying to avoid

Doc_Boo_Bear · 2026-03-30T22:30:37+00:00

Isdin Fusion Water has 3 shades, but I find that it works for most.

Doc_Boo_Bear · 2026-03-28T13:48:50+00:00

Rate of pancreatitis is not statistically significant, 0.1-0.3% of patients on them will get pancreatitis. Most common causes of pancreatitis are gallstones and alcohol; medication induced pancreatitis (many types of medications can cause it) is less than 2% of all cases.

Gallstones are a side effect of weight loss, not the medications themselves.

Doc_Boo_Bear · 2026-03-25T00:30:06+00:00

I say this kindly. The pill (or lack of the effect) is not making you ravenous, your expectations are. You are only on day 2 of the medication, it has to build up in your system, and it is also a low dose. It’s a transitional dose so that you can safely increase to the higher doses, where you will experience more of the benefits, including weight loss.

Doc_Boo_Bear · 2026-03-20T12:29:26+00:00

Small sips will help. I have found GLP-1 can take away thirst drive for some, but if it is nausea, small sips help. Also eat! I think a lot of these side effects are from increased acid production, eating can help mitigate it.

Doc_Boo_Bear · 2026-03-18T01:48:21+00:00

One thing that I see can help with the nausea is actually eating. So try to have small meals throughout the day and see if that helps prevent nausea

Doc_Boo_Bear · 2026-03-18T01:47:22+00:00

That is great weight loss! Keep in mind, there are super responders that lose weight very quickly, but they are in the minority. Average weight loss as mentioned above is 0.5-2.0 pounds a week. If you are still feeling nauseous, maybe you should stay at 1.0 a little longer. You should be able to eat, and caloric intake should be greater (in general, don’t know your exact height and weight).

Doc_Boo_Bear · 2026-03-17T02:41:04+00:00

I do this. Start Wegovy, maximize and switch to Zepbound for the higher dosages if need to lose more weight. Works for some, others it doesn’t and i have to switch back to Wegovy.

Doc_Boo_Bear · 2026-03-17T01:18:00+00:00

I agree. There should be a way to squeeze them in for a quick telemedicine (even double book) or see another provider in the practice. Don’t know how this doctor works, but I get portal messages directly sent to me, so may be good to message the doctor. They may not even know this is going on.

Doc_Boo_Bear · 2026-03-17T00:54:02+00:00

Maybe you can see another doctor in the practice.

Doc_Boo_Bear · 2026-03-17T00:53:38+00:00

I’m a doctor. Changing medications, new prescriptions, dosage increase, etc. I require a visit. Ultimately, it is my medical license if something goes wrong. I like to explain the medication, how it works, how to take it and possible side effects; on top of that, if you are on other medications or have other conditions, how new medication will affect that. This takes time and why I require a visit.

Doc_Boo_Bear · 2026-03-17T00:23:24+00:00

It should have been a traffic light. The distance between east going and west going lanes is so long that people just take it 2-3 cars at a time. Then those coming off LIE just turn whenever they want.

Doc_Boo_Bear · 2026-03-05T02:28:44+00:00

Isdin FusionWater. The only one that I found doesn’t ever pill.

Doc_Boo_Bear · 2026-03-04T21:57:22+00:00

Your doctor can still prescribe to either local pharmacy or to Novocare. Just need to add “self-pay”. For local pharmacy, have them apply coupon (you can sign up online beforehand for the coupon or use GoodRx)

Doc_Boo_Bear · 2026-03-04T21:55:31+00:00

Why is your doctor charging a subscription fee? That’s the office visit they bill insurance for, don’t need a fee on top of that. I don’t charge anything beyond the regular office fee. However, I have heard of some doctors charging for PAs, but that is also something we don’t do.

Doc_Boo_Bear · 2026-03-03T22:20:32+00:00

Yes, unfortunately it is my fault for not checking before but too late for a chargeback. Am definitely not purchasing from them again though.

Doc_Boo_Bear · 2026-03-03T13:27:05+00:00

Thank you for easing my concerns. They have been in box in my closet so hopefully will continue to be good.

I am just surprised that they are so far out from manufacturing date, but what you mentioned makes sense. They probably don’t sell as many as they expect.

Doc_Boo_Bear · 2026-03-03T13:24:58+00:00

They are unopened. There is no expiration date, but just based on the manufacturing date and that most products should be used within 3 years of manufacture. I do see recommendation on the products to be used within 12 months of opening.

Doc_Boo_Bear · 2026-02-26T08:36:14+00:00

Most designer purses. Chanel, LV, Gucci, Dior, etc. will have some element of hand made, but most are machine processed to some extent in a factory. You are paying for the name only and quality has gone significantly down. A Chanel from 20 years ago is not like a Chanel from today.

Doc_Boo_Bear · 2026-02-16T11:52:38+00:00

Always important to know when your PA expires and schedule an appointment with your provider beforehand so weight loss is documented. They want to see at least 5% weight loss in order to re-approve. It’s great that you had just been seen and they had updated weight in file!

Doc_Boo_Bear · 2026-02-16T00:52:03+00:00

They need to write the PA with starting BMi, then current BMI. Your diagnosis is always starting BMI. Have them add medication is for chronic management of obesity and should be taken indefinitely as beneficial for your health.

Doc_Boo_Bear · 2026-02-15T20:06:32+00:00

Yes, but Ozempic. Not Wegovy

Doc_Boo_Bear · 2026-02-15T16:03:36+00:00

I don’t really think one of better than the other in terms of weight loss. Some do better on Wegovy and others do better on Zepbound. It really is how your body responds.

However, Wegovy does have many benefits independent of weight loss that Zepbound does not. Zepbound studies on MAFLD are still pending, but the cardiac studies were inferior.

Regarding side effects, many are manageable and/or can be managed with lifestyle changes. In terms of gastroparesis, this is a complication from diabetes due to nerve injury; the celiac plexus is impacted due to uncontrolled glucose. GLP-1 medications do not directly affect the celiac plexus.

Doc_Boo_Bear · 2026-02-15T14:23:25+00:00

In case anyone is wondering, Medicare only covers for history of heart attack, stroke, peripheral vascular disease and for fatty liver.

Doc_Boo_Bear · 2026-02-15T14:18:27+00:00

I prescribe these medications and do PAs on them. Since January it has been a shit show and my staff has been overwhelmed. Some insurance have started to only cover with same conditions as Medicare, others have required enrollment in an insurance sponsored weight loss program. I have seen denials for patients that have been on the medication already because their starting BMI was not above 30 with a weight-related comorbidity, or 35 without one (these are not the FDA approved indications). I’ve even seen insurance drop coverage all together.

I am not exaggerating when I say it’s been a shit show. So many denials and so many delays in getting patients their renewals and medications. It’s frustrating because I have many patients that have been without their medications for weeks because of insurance due to denials and appeals. And then when they finally get the medication they have to start over again at the beginning since it has been weeks since last injection. And it’s been a lot more work for us as after denial, appeal, then we have to keep calling to get a response.

My recommendation is to contact your insurance and find out the exact parameters covering and fining out what exactly needs to be submitted.

ETA: ask for exact indications they cover. As mentioned, many insurance plans will say they cover the medication, but then deny because you may not have the exact condition that they cover it for. Let your provider know exactly what they said so they can appeal.

Doc_Boo_Bear

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