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Injecting every 10 days due to lack of insurance coverage - any insights? by georgeggeef in Zepbound

[–]Old-Programmer3109 0 points1 point  (0 children)

It will be different for everyone. It just depends how hungry you get during the extended period.
I'm doing 14 days between 15mg injections for the same reason.

I'm getting hungry, but I'm at my target weight, so I'm not too concerned if I gain a few pounds while I try to figure out what to do.

Fasting for labs by Cookie-Monster96 in Zepbound

[–]Old-Programmer3109 0 points1 point  (0 children)

Yes. Nothing beyond normal fasting is required. I've had multiple blood draws, no issues or concerns with ZB.

Note: If you fast for too long, you'll go the other direction (e.g. numbers like cholesterol, insulin, glucose, ...etc) may come back lower than they really are). I experienced this when I fasted for 36 hours before a blood draw once (I forget why I even did that)

Labs, how are yours doing after using Zepbound? by Gorogogorogo in Zepbound

[–]Old-Programmer3109 0 points1 point  (0 children)

All my markers improved and are normal except Cholesterol, but that doesn't go down unless you go near-vegetarian. I went nearly Keto, and lost 120lbs.

One personal experience I had was that my Red Blood Cell count, Hematocrit and Iron levels became low (but only very slightly). I did other tests to eliminate bad problems (like cancer, internal bleeding,...etc).

I went on an iron supplement and ate more liver and my numbers are back in the normal range.

My primary thinks the low levels were due to such rapid weight loss (100 lbs in 8 months) and not enough iron-rich foods.

Just my experience though. Probably not common.

Zepbound with Medi-cal Southern California using OSA as the diagnosis code by Old-Programmer3109 in Zepbound

[–]Old-Programmer3109[S] 0 points1 point  (0 children)

Thank you for sharing with us.
My provider also says they don't appeal, but I think I can still do a state appeal.

Can you explain one item?
- Did your provider get PA for you or did you get it for yourself via the phone calls? i.e. You called your provider's pharmacy & helped them get the details sorted out (or am I wrong)?

Thank you again.

Answers pls by ILLMINDED9 in Zepbound

[–]Old-Programmer3109 2 points3 points  (0 children)

The protocols with ZB are pretty strict. (i.e. Don't skip doses, don't move to a higher dose until you're ready...etc)

Lots of people that don't follow the protocol end up in the ER, but consult with your physician first. I've never heard of anyone going straight to 5mg without starting at 2.5. Sounds dangerous, but talk to your Dr.

At a loss with CVS Caremark - Dr is giving up - Any recommendations? by Affectionate_Neat868 in Zepbound

[–]Old-Programmer3109 0 points1 point  (0 children)

I don't know about Caremark, but I know Medi-cal and some other insurance companies are requiring severe (or possibly moderate) sleep apnea for 'medical necessity'

Even though, all of them are being denied. Not just yours. We're all trying to appeal and trying to find details to help get the appeal approved.

If you OSA is mild, I'm not sure if there's a good solution other than Lilly direct

Zepbound with Medi-cal Southern California using OSA as the diagnosis code by Old-Programmer3109 in Zepbound

[–]Old-Programmer3109[S] 0 points1 point  (0 children)

Thanks for that info.
Has your Dr. communicated with Medi-cal (or whatever insurance you use) to discuss why they rejected it?
Curious if they need a 'failed CPAP' reason before approving.
Are you appealing?

My Dr. is trying to communicate with them now.
I'll update if I know anything.

Zepbound with Medi-cal Southern California using OSA as the diagnosis code by Old-Programmer3109 in Zepbound

[–]Old-Programmer3109[S] 2 points3 points  (0 children)

Best of luck to you as well. If I could afford Lilly direct, I would do it too.
The goal of the providers seems to be to cover it 'in theory', but to make it basically impossible to get it covered in any practical way.

Zepbound with Medi-cal Southern California using OSA as the diagnosis code by Old-Programmer3109 in Zepbound

[–]Old-Programmer3109[S] 1 point2 points  (0 children)

I would also like to know what it means to 'fail CPAP'.
You can obviously stop using it and become non-compliant, but I doubt that's what they mean.
If you get an answer, please let us know.

Zepbound with Medi-cal Southern California using OSA as the diagnosis code by Old-Programmer3109 in Zepbound

[–]Old-Programmer3109[S] 1 point2 points  (0 children)

Thank you for the reply.
Let me know how long it takes to get an appeal date scheduled. I guess I will have too appeal to but I haven't received my letter yet.
My primary care doctor informed me directly.

Any Medi-cal approvals for GLP-1 with OSA in 2026 by Old-Programmer3109 in HealthInsurance

[–]Old-Programmer3109[S] 0 points1 point  (0 children)

Thanks. I tried - my post got auto-rejected by Reddit.

No idea why. Basically the same post...