By skyforbes Hi, I have a question regarding coverage on ozempic/wegovy. I am 30 years old, 5”5, 240LBS, BMI is 39.9 (severe obesity (Class 2)),
high triglycerides, I have had my weight monitored by my doctor closely for over a year now (once a month, sometimes more) my treatment plan goal for myself and my physician has been “weight loss” and has been for a year (documented,) with very minimal weight loss. in counseling for weight related issues. I’m a recovering addict (4 years sober) so my doctor does not want me on any stimulant medication, I’m already on a medication that has naloxone so I can not take anything with naloxone in it, I have had a documented negative side effect to Metformin, I have clinical anxiety and bipolar disorder order type 2 diagnosed over 12 years ago. Therefore I can not take the “preferred medications” they require before getting the other medications. My doctor sent a prior authorization for ozempic,
With the above stated information.
My insurance (Aetna better health of Illinois) denied the claim due to: “The FDA has not approved the medication for weight loss, the FDA does not approve ozempic for weight loss because it is not considered safe or effective.” So I’m wondering, being that wegovy is approved for weight loss if my doctor sent in a new script with a prior-authorization for wegovy with the same above information, but adding in that wegovy is approved for weight loss by the FDA, do I have a chance of getting it covered ?
high triglycerides, I have had my weight monitored by my doctor closely for over a year now (once a month, sometimes more) my treatment plan goal for myself and my physician has been “weight loss” and has been for a year (documented,) with very minimal weight loss. in counseling for weight related issues. I’m a recovering addict (4 years sober) so my doctor does not want me on any stimulant medication, I’m already on a medication that has naloxone so I can not take anything with naloxone in it, I have had a documented negative side effect to Metformin, I have clinical anxiety and bipolar disorder order type 2 diagnosed over 12 years ago. Therefore I can not take the “preferred medications” they require before getting the other medications. My doctor sent a prior authorization for ozempic,
With the above stated information.
My insurance (Aetna better health of Illinois) denied the claim due to: “The FDA has not approved the medication for weight loss, the FDA does not approve ozempic for weight loss because it is not considered safe or effective.” So I’m wondering, being that wegovy is approved for weight loss if my doctor sent in a new script with a prior-authorization for wegovy with the same above information, but adding in that wegovy is approved for weight loss by the FDA, do I have a chance of getting it covered ?
Thank you for any help!