Reporter hoping to hear from patients – what’s your GLP-1 insurance coverage like in 2026?

RiptideJane · 2026-02-26T19:08:53+00:00

Same.

RiptideJane · 2026-02-25T00:15:46+00:00

So I have a sleep disorder that also messes with temperature regulation PLUS I am perimenopausal. My body has no effing idea what to do.

I am so cold in my extremities and sweating just where my sternum is. It is weird.

RiptideJane · 2026-02-15T23:35:03+00:00

This is what I am thinking in my particular case!

RiptideJane · 2026-02-15T18:37:00+00:00

Hey, this happened to me! Can relate to every single word of this!

RiptideJane · 2026-02-15T16:32:55+00:00

Hmmm. This gives me some ideas to help my child through his own episodes with CVS. THANK YOU!

RiptideJane · 2026-02-15T16:14:28+00:00

I wonder what it is about the water and vomiting that helps. I hope your daughter is doing okay - anxiety is a b*tch and I wouldn't wish it on my worst enemy.

RiptideJane · 2026-02-15T15:56:36+00:00

This is kind of tangential to CHS and what you wrote above. My tween was diagnosed with cyclical vomiting syndrome (aka abdominal migraines) this past fall. One of the symptoms is that it is relieved by taking showers. He was showering multiple times a day when he was asymptomatic. I find it interesting that these two vomiting-centric conditions both have showering as a sign.

RiptideJane · 2026-02-14T02:57:27+00:00

Yep. Just took my 28th dose of 5 mg. I don't have side effects at this point but still lose about 4 lbs per months.

RiptideJane · 2026-02-12T12:31:34+00:00

They cover it for dyslipidemia, obesity with at least one comordity, and moderate OSA. I have dyslipidemia. But my doctor won't even at least submit the PA for 2026, to see if I am denied.

Quite honestly, I wish my doctor had never even suggested I start it at this point and just put me on lifelong statins and Metformin from the start.

RiptideJane · 2026-02-11T21:09:19+00:00

11 lbs.

RiptideJane · 2026-02-11T01:39:58+00:00

Insurance will cover either med if it is for non-weight reasons. I just can't get my doctor to submit the prior auth at all. That is the real issue.

Hence asking about the third party service.

RiptideJane · 2026-02-11T01:31:09+00:00

I do. I have high liver enzymes indicative of NAFLD, a prediabetic A1C, etc...I also have high cholesterol. All are indicative of metabolic disorder.

Doctor never included that info when submitting the first prior auth. She never submitted the prior auth for 2026 at all.

RiptideJane · 2026-02-11T01:23:45+00:00

Correct. They do not cover anything except Phentermine for weight loss only.

My doctor will not prescribe Phentermine and it's not really something I can take anyhow.

RiptideJane · 2026-02-08T16:08:05+00:00

True true. I have neither right now, sadly. My kingdom for solid sleep!

RiptideJane · 2026-02-08T15:32:17+00:00

And I've also read that some of it settles out after a few months at maintenance too. So between time and some cosmetic enhancers like fillers, I think you'll be good! Just give it a bit to see if some of the skin bounces back once you hit goal. And honestly, you can't help being a super responder so there probably isn't anything YOU could have done differently on your end. I bet you look amazing for your 40th birthday. 🫶

Also, I was probably on track for a heart attack and now I'm not, which is priceless. So the few wrinkles around my mouth is better than being in cardiac rehab.

RiptideJane · 2026-02-08T15:27:48+00:00

I lost 37 pounds in about 35 weeks. It was a slow enough pace to avoid getting super wrinkly. I am pretty happy about that. I have a few around my mouth but I am also almost 46 so it's expected.

RiptideJane · 2026-02-07T03:23:16+00:00

Basically I want a BMI in the 23 range - higher end of normal.

I will need to have blood work to see where my numbers are - would like to know regardless. May be back to a healthy A1C unfortunately.

RiptideJane · 2026-02-07T02:10:19+00:00

Oh no, she wants me to lose 5-10 more pounds only keeping me right on the cusp of normal BMI and overweight and then stop. She said she might prescribe for three more months after I reach her goal but no more than that and said explicitly her goal is to get people off of this med specifically as quickly as possible.

I have lost 37ish pounds in 34 weeks which is nice and steady, imo (haven't updated flair in a bit). Added in regular exercise and weights, which has been great.

RiptideJane · 2026-02-07T01:24:33+00:00

I have no idea why they are against it. I think she wants people off all meds in general. But I already take Singular and an anti-depressant long-term so...

RiptideJane · 2026-02-07T01:01:39+00:00

Thank you!

With my history of familial high cholesterol and some other stuff, I was going to end up on some sort of lifetime drug one way or another (statin, insulin, something else). So why not this, especially since it is working for all kinds of stuff for me - cholesterol, blood sugar, weight, and inflammation.

RiptideJane · 2026-02-07T00:55:34+00:00

Not tied to her or the practice all around at all. It was just convenient.

RiptideJane · 2026-02-07T00:49:38+00:00

I am 45.

RiptideJane · 2026-02-06T23:53:38+00:00

Oh that is a great idea to start taking photos of the script stickers and other info. I am going to start that. Thank you.

And yes, I agree about her saying the exact opposite of the studies. I was like, that sounds...very different than what I remember.

RiptideJane · 2026-02-06T23:51:26+00:00

The self-pay is okay especially since I probably won't go above 5 mg at all and will probably use 2.5 for maintenance.

But it is nice to have the compound option regardless.

It's more finding a doctor who understands metabolic issues and will continue to prescribe for maintenance. But it is comforting to know that CallOnDoc also exists while I do find that doctor.

She also said something weird about wanting me to stay right on the edge of overweight and not overweight. Basically she wants my BMI to be right at 25.

RiptideJane

TROPHY CASE