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Insurance Coverage
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My stash is almost gone and I have been fighting to get continued access to the med for months. Other sources are not realistic for me and insurance seems to be the only option. I’ve lost over 50lbs but still have over 100 to lose. Predictably my PA was denied but only because tirzepitide under Mounjaro is not covered. Apparently Mounjaro is not on the formulatory but Zepbound is. My doctors office is insisting that Zepbound will not be covered anyways and I am having a hard time getting them to do the PA. I know it’s a long shot but it’s a least worth a try. I’ve had such a pain trying to establish any long term care so my pcp knows nothing about my medical history, making even more difficult. I tried calling myself to ask for typical approval criteria but they said that they couldn’t give it to me. Does anyone have any idea why insurance would include Zepbound and not Mounjaro in the formulatory? Does it point to a potential coverage for weight loss?

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2 weeks ago