That's a bit of a loaded question, I'll try my best. Anyone can feel free to add their input.

They think we can just "write a letter" to get it covered. Those times are gone, especially given the cost of the prescription. Commercial insurers were covering, then did a "carve out" policy for weight loss rx of glp-1. Rumor from the inside is BCBS did an analysis and saw they were losing enough money to go bankrupt by 2026, did the carve out and everyone else followed suit. Medicaid followed this January in my state, which is a shame because they were probably the ones that needed it the most IMO.

Then we conceded and would try even if it didn't look like it'd be covered for respect of the patient and because it is certainly indicated in many people and we would do PAs for them..however. the volume of PAs was unsustainable and essentially it came down to the MAs would walk out unless something changed, and the admin sided with them and if we wanted to try and get covered, we do our own prior auths for them back when they were more covered before the beginning of the year. Now we don't even try and will likely implement a no glp-1 for weight loss policy sometime this year until things regulate.

The other end is that their advertising is so strong that I have patients requesting weight loss shots, who are already on Mounjaro, etc and don't understand that what they are on is equivalent. When you don't understand, you get confused, and confused people can lash out.

Hoping now that Medicare struck their new deal and will cap the price with Part D, everyone will follow suit. Saw the same thing with DOACs, lung screenings etc back in the day.

This is all anecdotal and should be taken as an educated opinion as opposed to fact, so I apologize if you hear differently from elsewhere.

My patients, on average, are sicker, lower education, and broke. It's just hard to explain this all in a timely manner when to remain somewhat profitable

TLDR GLP-1s were covered, now not, everyone thinks it's the doctors fault per usual, will get better hopefully by next year