Mounjaro being denied. A CT scan costs approximately $600-$1,000, although more extensive CT scans can cost much more. Best. Mounjaro is not indicated for use in patients with type 1 diabetes mellitus. I was 300 lbs at this point. I'm a pharmacy technician and deal primarily with insurance and prior authorization, I can tell you that pharmacy staff are extremely short staffed and overwhelmed , I can also tell you that on the new Maunjaro coupons with the type 2 diabetes being stated on the card can cause issues based on the diagnosis code the doctors inputs on the prescription. However, I pay an insurance premium monthly and when I am denied a medication that I need, it is extremely frustrating. Losing at least 2 lbs a week on 12. TikTok video from Stacey Savage (@staceysavage13): “Follow my journey after being denied a Mounjaro prescription at the pharmacy. Don’t just give up due to comments saying Medicare does cover it. pa approved and thankfully got approved 3 days after my appt. Hi there! It looks like your post is about the availability of Mounjaro. The list price for Zepbound is about $1,060 for a 28-day supply. 4. Your insurance company isn’t going to care that “a study in 2021 showed that Mounjaro lowered blood glucose” which is the sad extent AI provides to the request. 5mg Sorry if this has already been asked before. Everything is just so disgusting and makes me want to puke. Sometimes this reason includes information about its formulary and what is called it’s “criteria If you are denied coverage for Ozempic, Mounjaro, Wegovy or Zepbound, Honest Care can help fight your denial by submitting an ‘appeal’ to your insurance. After 2 denied prior authorizations and one appeal, I got approved for my 12. 5 were all very effective at first and then stopped being so effective for weight loss. Then Mounjaro. While these medications are extremely similar, there are four areas in which their differences are palpable Hey everyone! Excited to start on this medication soon. Unfortunately coverage denials too often go unchallenged. I was diagnosed with T2 two weeks ago, and I have been on 2. #mounjarojourney #mounjarodenied #mounjaroprescription #mounjaro”. August 2023: Mounjaro 5mg, no coverage. Many insurers require " prior authorization " for drugs they don’t A pharmacist displays a box of Mounjaro, a tirzepatide injection drug used for treating type 2 diabetes and made by Lilly. I am prediabetic and have been on metformin for a year with no change to my A1C. The insurance compnay is auditing charts and those that do not have diabetes on file are being denied, even with the coupon. Mounjaro & Ozempic: If you were denied coverage for either Mounjaro or Wegovy, review your denial letter for medications including Metformin, Victoza, Rybelsus or Byetta. [10] [13] It is sold under the brand names Mounjaro for diabetes treatment, [10] and Zepbound for weight loss. However, I am wondering if I messed up by choosing it because of my insurance. An appeal is a formal request to your health insurance UHC fires back and says denied again. I'd been intending to settle down and google what had occurred, but it wasn't dawning on my way of thinking that my having begun Mounjaro, after years (and years) of Victoza, might possibly have been the contributing factor. 5-7. Get app Get the Reddit app Log In Log in to Reddit. I am not on Ozempic. For the first time in a decade Insurance denied PA . Tirzepatide has also been linked to significant weight loss. As of January 2024, PA required and denied. An appeal is a this class. ” I feel like I’ve wasted months trying to get this drug, I’ve been type 2 for 10 years kept getting denied. 6. Wegovy, on the other hand, was FDA-approved for weight management in 2021. The savings coupon was covering the cost for those whose plan didn’t cover Mounjaro. As a side note I have actually gained 10lbs since If your insurance denied coverage for Ozempic, Mounjaro, Wegovy or Zepbound, you have the legal right to ask your insurance to reconsider the coverage denial by sending an ‘appeal’. In fact, because I had gestational diabetes while pregnant and the fact Mounjaro is in many ways similar to another popular diabetes drug, Ozempic®, which has also been garnering buzz for its weight loss effects. Basically told me that they aren’t allowed to give it to anyone except for diabetic patients. The card expired on 6/30/23 and several plans required a PA as of 7/1/23. Ozempic was the only thing that had changed for her. in one year. In early May, my primary care doctor retested my A1C which came back as 6. I think Mounjaro is a true ‘miracle Mounjaro works by increasing the production of insulin and reducing the amount of glucose produced by the liver. Did you have to wait for the prior auth to be denied before using the coupon? Please Store MOUNJARO in a refrigerator (2°C - 8°C). I think I’ll try for 5-8 more pounds. Unfortunately, you'll have your appeal denied without ever getting an audience with decision makers who can influence policy changes. Covering the cost of Mounjaro not only promotes my health and well-being but also has the potential to reduce the burden on the healthcare system in the long run. What should I do if I miss a dose? Take the missed dose as soon as you remember it within 4 days after the missed dose. By focusing on sustainable lifestyle changes and viewing each phase of your journey as a chance to deepen your understanding of your body and health, you can work towards lasting improvements in your quality of life, with or without medication. Your dr is trying to take a proactive approach to prevent T2 diabetes and mounjaro will help facilitate that. Archived post. Patients can’t fill prescriptions. My doctor tried this with Saxenda was Navitus denied it. Mounjaro Prior Authorization Process Tips Indication and Select Safety Information Indication: Mounjaro is indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus. When refrigeration is not possible, you can keep your vial at room temperature (below 30°C) for up to a total of 21 days. Mounjaro denied bc I don’t have diabetes? I was on mounjaro for three months before supposedly Mounjaro manufacturer revoked access to the medication because I don’t have diabetes. 08 per fill. Overall, people have had amazing success with semaglutide so I think you’ll do great. I don't plan on changing it if I have to stop medication for any reason. Even if Mounjaro is not on your formulary, you may still be able to overturn GLP-1 coverage denials through an effective appeal. So now I have to try other medications and if not successful after two medications I can get Ozempic approved again. I started Mounjaro in August after switching from Ozempic which destroyed my GI tract. Today our pharmacy said they can no longer fill Mounjaro for non-diabetic patients. Most insurance plans coverage Mounjaro for the treatment of Type 2 diabetes, though some insurance plans may require you to try Ozempic or Metformin first. [11]Tirzepatide is a gastric inhibitory polypeptide receptor and GLP-1 I have been taking Mounjaro for a little over a year. Mounjaro (tirzepatide) is a medicine approved by the FDA in May 2022 to help lower blood sugar (glucose) in adult patients with type 2 diabetes. Keep MOUNJARO in the original package in order to protect from light. “First time, I tried to refill Ozempic in February, CVS Caremark denied For patients with commercial drug insurance coverage for Mounjaro: You must have commercial drug insurance that covers Mounjaro ® (tirzepatide) and a prescription for an approved use consistent with FDA-approved product labeling to pay as little as $25 for a 1-month, 2-month, or 3-month prescription fill of Mounjaro. You can also find information on the drug’s strengths, forms, and more. When he submitted the PA for Trulicity, he cited what the denial said. An appeal is a formal request to your health insurance company to overturn their denial and grant coverage on your behalf. That being said, once you get to a consistent dose, they’ll give you refills, so it’s not an every month cost Reply reply AlternativeBar7905 • I was paying $164. 5 PCOS (diagnosed I have been seeing a lot of posts regarding issues with insurance coverage on medications, specifically GLP-1 analogs (Ozempic, Wegovy, Mounjaro, Zepbound). If you’d like help sourcing Mounjaro, be sure to include your dosage and location in your post. They only see money. First, review your policy to understand what is covered. Finally today I found out that my insurance (express scripts) will only cover it if I get a 3 month supply! The first two times you pick up a medication, you can get a 1 month supply, after that you have to get a 3 month supply and it can only be picked up at a walgreens. So I called the Pharmacy and the Pharmacy Tech was super rude and dismissive. The reason is the medications' cost, which can run more Her doctor submitted a PA which was promptly denied. Patients must have commercial drug insurance without Mounjaro coverage and a prescription consistent with FDA-approved product labeling to pay as little as $25 for 4 pens of My insurance doesn’t cover weight management drugs, and only covers ozempic and mounjaro if you have a T2D diagnosis and have not seen improvement on Metformin. I am just worried I am going to sign up Trulicity and similar diabetes drugs like Ozempic and Mounjaro, have all been in short supply over the last 18 months. I am thankful to have not experienced I kept seeing research material listing Heart & sympathetic nervous system rate increase being typical but normally comes down. Wouldn’t I've been taking mounjaro for 7 months now and I have less energy and to the point of where I can't eat much of anything but half a cracker a day. This rule does not ban posters from being blunt, brusque, terse, or gruff when it is appropriate and not excessive. Left with limited options, I was prescribed metformin, which did not suit me well. April 2023: Mounjaro 2. Any ideas? I’ve lost 25 lbs, feel fantastic and notice a HUGE difference since I’ve missed this injection. I went to fill my prescription, and the pharmacy said the coupon didn't work. Have been taking it regularly for over a year now, and have moved to a different The trend for celebrities pursuing the ultimate slim line figure appears to be picking up speed with more and more famous faces becoming unrecognizable after drastic weight loss every week. 99 each month for my refills ($150 provider fee + $14. My last lab results have me now hyper instead of hypo. Top. If you’re having a hard time finding your dosage at a pharmacy near you, be sure to check the FDA Drug Shortage List to see if your dosage is facing supply issues. They were covering Mounjaro for me that was prescribed through Push Health with a PA, but once I moved up to 10mg, they denied it asking for step therapy. com Marketed by: Lilly USA, LLC Indianapolis, IN 46285, USA Mounjaro, for example, is only approved by the FDA to help type 2 diabetics control their blood sugar. I’ve told the insurance if my sugars go out of 77K subscribers in the Mounjaro community. Whether your Mounjaro has not been studied in patients with a history of pancreatitis. I kept up with all of the lifestyle changes along with Mounjaro & I’ve lost 65 lbs. Mounjaro is not FDA-approved for weight loss in a patient who is The crazy thing is, the denial for Ozempic says I have to have used Trulicity with no success. One month is defined as 28-days and up to 4 pens; 2 If you have questions about how to save on your Mounjaro prescription, or if you have additional questions, please contact the Mounjaro patient services support center at 844-805-5807. Consequently, I turned to Mounjaro, which I've been funding out-of-pocket for 6 weeks. If it us denied, can I use the coupon I have? Also on the live broadcast, Jennifer denied using Ozempic but admitted to being on Mounjaro, which is similar to Ozempic. The current dose might be too low: Mounjaro starts at a lower dose and gradually increases from 2. I want to do a triathlon now that I’m not carrying around all the extra weight on my petite frame. Now I’ve been denied by my insurance United Healthcare. Came home and the Mounjaro was missing. I have been on Mounjaro for 20 weeks now. I thought I'd post my initial experience as well in case it is useful to anyone just starting out. Each fill has 4 prefilled pens, amounting to a 28-day supply. 5mg and 15mg of tirzepatide, injected under the skin of a patient’s stomach area Her original Dr has to relocate during that time but a new in at the practice agreed with the plan and continued to help collect information on her progress with Mounjaro. because my AC1 is not high. Open menu Open navigation Go to Reddit Home. 5 for one week using the free sample coupon. Having launched in the UK in February 2024, it may be even more effective than other weight loss drugs like Wegovy and Ozempic. I think if I end up needing Mounjaro for maintenance long-term, I would prefer to get the vials and split doses to reduce cost. Ever since starting mounjaro I’ve been so cold. Mounjaro (tirzepatide), an injectable prescription medicine, is indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus. But I’m reading in the Facebook posts that people are now being denied refills and dose increase refills due to not having diabetes. It has been amazing! Until today. Ozempic Wegovy and Mounjaro can have unpleasant side effects, the most common being nausea and vomiting, heartburn, constipation, diarrhoea, stomach pains and headaches, which affect around 10% of people taking them. We all know that Nothing changes if Nothng changes. All cards issued/downloaded in 2023 expired as of December 31, 2023. Scan this code to launch www. Open comment sort options . true. We went in on the basis of me being prediabetic with a BMI > 40. Ozempic goes by the generic name semaglutide. More severe, but rarer side effects reported have included pancreatitis, kidney problems and thyroid tumours. I pay $452 per month for Mounjaro because it’s been really effective and I look at it like I’m not paying my health insurance so it evens itself out. I was fortunate enough to have Wegovy covered however, my doctor mentioned Zepbound/Mounjaro as a next step since I stalled on Wegovy and am still a bit away from my goal weight, so why not let’s give it a go and he wrote the prescription. The only thing that has brought my levels back to normal is the Mounjaro. Without insurance, you could pay a retail price anywhere from $1,000 to $1,200 or more per month. 9 and I weighed 250 lbs on insulin. If Wegovy truly is available again, yes, they may have a weight loss patient I have Premera Blue Cross they have been covering my mounjaro since May with a prediabetes PA on file. 6, I weigh 185 lbs, and I no longer take insulin. 5mg, no coverage, $1200. "Mounjaro is always started at a dose of 2. Waiting on the Dr. I’ve been reading all about $25 savings card and got one from Elililly website. Q&A. I did an expedited appeal of the denial (takes 48-72 hours for the entire process) but during that appeal a rep spoke with me and asked for what dosage it I’ve been in Mounjaro since 7/25/22. If it's been more than 4 days since your dose was due, skip it and continue with your usual dose moving forward. The side effects are harsh at this dose for me. I wanted back on Mounjaro because it felt it worked TONS better than I’m pre diabetic and I’ve been on Ozempic for over one year and I was having great success tolerating and lowering my A1C. An appeal is a formal request to your health insurance company to Mounjaro™ (tirzepatide subcutaneous injection ( Lilly) is(are) considered experimental, investigational or unproven for ANY other use(s) including the following (this list may not be all inclusive; criteria will be updated as new published data are available): 1. Today my mounjaro was in the process of being refilled. About 3 weeks off now & HR dropped more towards where I’ve been on Ozempic for my & my a1c went down so did mt weight, now my a1c has gone up and my Ozempic has been dented because my a1c isn’t high enough. How we compared semaglutide and tirzepatide. Skip To Main Content Menu Menu closed Close Login / Register Medical Home A community exclusively for type 2 diabetics using Mounjaro, Ozempic, or some of the other drugs that were created for type two diabetes, but increasingly being used for weight loss. 5mg, 5mg, 7. Learn more about the drug's half-life, how long it stays in your system, and more. Good luck! I am frustrated. By prioritising nutrient-rich foods while avoiding sugary, processed, and fried options you can optimise your weight loss results but also keep yourself healthy to support your overall health and wellbeing. For Mounjaro, the clinical trial was carried out over 72 weeks with the following results on each maintenance dose:. Explore the challenges and find out more about Mounjaro drugstore. 5% of Ultimately, Mounjaro is a tool in your health journey, a powerful one, but still just one part of a comprehensive approach to well-being. Now pharmacy states “Claim does not qualify for this offer”. My wife is a doctor and she says that a diagnostic code is attached to the They received it, but it was still denied. I asked why they covered my fills in January and February and they said they were pushed through somehow and shouldn’t have been. But I think the drug itself is being denied by my insurance no matter what mg it is. Rules: be nice, no bullying, no discussion of unproven “natural” diabetic drug alternatives, and **no discussion of coupons, please**. I cannot appeal or obtain approval because it's specifically excluded compared to only being non-formulary. My hopes for continued use of Mounjaro were crushed yesterday when I received an email notification from CVS Caremark stating that my appeal for prior authorization of insurance coverage for Mounjaro has been denied. Caremark (my rx ins company) denied it after Dr sent PA TWICE. 5. I am employed, so my health insurance covers the costs. An appeal generally consists of a formal letter, addressed to your insurance, explaining Mounjaro, a medication initially developed for managing type 2 diabetes, has gained significant attention for its efficacy as a weight loss drug. These That being said, r/Mounjaro is also not a kindergarten classroom, and posters will be expected to own a helmet and skin thicker than rice paper. I've lost 97 lbs and today, after waiting for Skip to main content. My doctor says it’s okay as long as I stay #mounjaro #weighlossjourney Mounjaro works by increasing the production of insulin and reducing the amount of glucose produced by the liver. 00 a month scares me as to what will happen without it. If you notice more severe symptoms (such as swelling under your skin and Or if they’ve had it denied, were you able to use the manufacture savings card? (Yes I know it excludes government insurances, but was curious if it was allowed if denied) Archived post. ABC. My rx has been I can’t offer help on your specific situation, however I also have Cigna (non T2D) and they do require a PA (mine was denied) and they do enforce a quantity limit (although 2ml seems There was a small amount of tiredness & day-sleepiness for a few days which still persists, as my body is being reset into a new eating regime while being denied of the usual carbs. It was approved by the FDA for chronic weight management in November 2023. That's why my doctor prescribed Mounjaro to help manage my type 2 diabetes by lowering my blood sugar. those taking 5 mg lost 16% of their starting weight; those taking 10 mg lost 21. It is used in addition to a weight-loss diet and exercise plan. New comments cannot be posted. 99 push health fee) plus $25 at the pharmacy. What's my next step after this? I'm sick of bugging the hell out of my doctor and his nurses and don't feel he's done anything wrong. Sorry - I had to open it up to find my original prompt: “Write a letter to Blue Cross Blue Shield of Illinois requesting an internal appeal and formulary exception to prescription of Mounjaro for treatment of Type 2 Diabetes and mention previous use of Metformin, Actos, and Ozempic, which caused severe intestinal symptoms and cite studies If you are denied coverage for Ozempic, Mounjaro, Wegovy or Zepbound, Honest Care can help fight your denial by submitting an ‘appeal’ to your insurance. This letter will include your policy details, specific decision you disagree with, Back in March my primary care doctor prescribed Mounjaro but my A1C was 6. However, it's important to remember that denials can be appealed, and there are steps you can take to increase your chances of overturning the decision. However you can ask you doctor to appeal it and you can also petition for an appeal yourself. Unfortunately, the legal team at that price decided that they were no longer going to advocate for their clients in regards to certain medications, Mounjaro being one of them It takes time for your body to adjust to Mounjaro: It can take up to 8 weeks for Mounjaro to reach a level known as its ‘steady state’ where it remains stable in the blood. I just don My Push provider wrote a PA that was denied (which we expected). One month is defined as 28-days and up to 4 pens; 2 Mounjaro (Tirzepatide) is a prescription medication indicated for managing blood sugar levels in people with type 2 diabetes. 4, so BCBS denied because I was not T2D. Members Online • Ok-Cry-3303 Well, not the "stuff" being clear, lol, but just making sure the colon is clean as a whistle, lol, aka empty Reply reply Ok-Cry-3303 • There ya go! The yellow caught me off guard though so I'm all about sharing what I learn. In summary, adopting a balanced diet while on Mounjaro is key to enhancing weight loss and overall well-being. My endocrinologist put me on for PCOS symptom management and to help with weight loss. Just because I don't have diabetes now, doesn't mean I won't have it in the future. I am really upset and at a loss. The denial seems unfair, unfounded and confusing, given the clear benefits I have experienced during the past ten months. In both male and female rats, tirzepatide causes dose-dependent and treatment-duration-dependent thyroid C-cell tumors at clinically relevant exposures. With Wegovy not being available, Mounjaro & Ozempic have been approved many times for weight loss for patients meeting the Wegovy indication. Controversial. If you are denied coverage for Ozempic, Mounjaro, Wegovy or Zepbound, Honest Care can help fight your denial by submitting an ‘appeal’ to your insurance. Mounjaro is indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus. After 3 months it was about Normal maybe 5 clicks higher during sleep. Amplus has been helping forward-thinking clients with their energy needs by providing Solar power as a service (SPAAS) with unparalleled experience, expertise & results. If you've been prescribed Mounjaro, or are thinking about starting a weight loss treatment with the medication, you're likely curious about what to expect. Your company covered Mounjaro for ONE MONTH before asking for a PA and once again, my hopes of being healthy came crashing down around me. When I tried to get my fourth box of mounjaro, the pharmacy said that lily 192 votes, 63 comments. Trulicity was still denied even though it was the “next step” after the Metformin and Januvia. Mounjaro is not FDA-approved for weight loss in a patient who is 192 votes, 63 comments. Have been on mounjaro for a year with great results, and suddenly my insurance stopped covering?? Started on mounjaro with plushcare sometime last year with Blue Cross Blue Shield. There's also the condition that it's being used in accordance with a prescription consistent with FDA approved labeling. If it was left out for a few days (or in your carry on while traveling) but did not exceed the top temperature of 86F, you simply put it back in the refrigerator. I'm insulin I requested preauthorization for off label use but was denied since pre authorization apparently requires diagnosis of type 2 diabetes. DO NOT use if it has been frozen. Mounjaro is a once-weekly injectable medicine that comes in a single-dose pen. However, like many . There just seem to be few patterns to This is really helpful information! Thank you. c So everybody was yelling at me, saying that my head is too big for my body, it’s just my hair, and that I gotta stop taking Ozemic because their family members can’t get it. She claimed they didn't have the script anyway and she put on my hold for over 10 minutes If you are denied coverage for Ozempic, Mounjaro, Wegovy or Zepbound, Honest Care can help fight your denial by submitting an ‘appeal’ to your insurance. An appeal generally consists of a formal letter, addressed to Mounjaro™ (tirzepatide subcutaneous injection ( Lilly) is(are) considered experimental, investigational or unproven for ANY other use(s) including the following (this list may not be all inclusive; criteria will be updated as new published data are available): 1. I’ve been using Mounjaro since November of last year, always with the $25 coupon. Re: Appeal of Prior Authorization Denial for Mounjaro Off-Label Use Dear [Insurance Company Name], I am writing to appeal the denial of coverage for Mounjaro on [date of denial]. I get another letter saying I can’t get Ozempic bc I do not have diabetes type 2. That means Mounjaro costs over $12,800 annually, at the list price. I’ve already I also have UHC choice plus. Regular-Sock-3180 • TRICARE denied my The list price for Mounjaro is approximately $1,069 per fill. Do not allow the vial to freeze. I have been prescribed this medication by my physician, [Doctor’s name], to treat my [condition]. I have taken ozempic and mounjaro and feel that my mood has been better. The Mounjaro brand is not approved by the FDA for weight loss. I really think it depends on what your employer chooses to cover. A fill contains four pre-filled pens, which is equal to about a month's supply of Mounjaro. I have been on Mounjaro for 2 months now and have been using the coupon for the cost. Reviewing Your Policy. Limitations of Use: Mounjaro has not been studied in patients with a history of pancreatitis. I’ve been in Mounjaro since 7/25/22. I was really bummed my insurance denied Mounjaro for me. My dr spend 4 hours one day on the phone with the UHC pharmacist who finally approved my PA. Share Sort by: Best. It is an injectable medicine administered once a week to help the body control blood sugar levels and reduce appetite. So I called mounjaro, and they said that as of 10/1/22, they are no longer giving the coupon for weight loss, only type 2 diabetes. Questions, experiences and accomplishments related to Mounjaro and Zepbound prescription medications. My Dr had me try Hydroxyzine but the effects lasted too long. I’ve been on Mounjaro for 10 weeks. Anyone had this happen ? This thread is archived New comments cannot be posted and votes cannot be cast comments sorted by Best Top New Controversial Q&A Mounjaro Questions, Experiences, Accomplishments! For compounding questions visit please visit r/tirzepatide Members Online • usernamezarelame . 5 mg but I needed I was the same way! I was really considering paying the $500 a month to stay on Mounjaro and did pay that for two refills. Track mine during sleep. Mounjaro’s active ingredient, tirzepatide, was used in the Phase 3 SURMOUNT-1 72-week weight loss clinical trials. Meaning either OP was given Saxenda for an off label use (odd that they'd give Saxenda for T2DM, but I guess it's theoretically possible), or OP is (more likely) ineligible to use the coupon and doing so would be a federal crime (health care fraud - 18 USC Dr needs to state that you already being pre-diabetic paired with insulin resistance and pcos will turn into full blown T2 diabetes if not addressed now. I will be stopping Mounjaro within the next 3 months. But I’m so glad I made the switch! Im still only 1 week in but the transition has been great for me. Apparently we had the appeal for 2. Mounjaro (tirzepatide) injection - Lilly Medical The pharmacist says that the card can only be used in conjunction with insurance and now my insurance has denied my mounjaro. The combination of these medications can help: * Lower blood sugar Are you sure you had a PA from last year as Mounjaro was available in June of 2022 with the $25 copay card. It’s considered a Tier 3 drug, so whatever your copay is for Tier 3 meds, is what you’ll be charged, depending on where you are in the donut hole. New comments cannot be posted and votes cannot be cast. Patients who maintain at 10mg, lose on average of 19%, while patients who maintain at 15mg, can lose I work for a large bank and the insurance that I have through them covers Wegovy, Ozempic and even Mounjaro through a Prior Authorization. An appeal is a formal request to your health insurance company to overturn their denial Doses 2. Expand user menu Open settings menu. Log In / Sign Up; Advertise on Reddit; Shop While I have never had a diabetic A1C (always under 6. I had it prescribed through alpha medical and its been sent to the pharmacy. The PA process with them takes weeks and I had to travel for work so I decided to pay out of pocket and 37 votes, 110 comments. While some have been open about their off-label use of Type 2 Diabetes drugs like Ozempic and Mounjaro to aid their weight goals, others are keen to deny they have done If your insurance denied coverage for Ozempic, Mounjaro, Wegovy or Zepbound, you have the legal right to ask your insurance to reconsider the coverage denial by sending an ‘appeal’. Not being able to get it due to my share of cost being $789. [11] [16] Tirzepatide is administered via subcutaneous injections (under the skin). Navigating Your Insurance Plan. Duhhh I have been on MJ. 1 if you are a cash paying customer you cannot use the coupon. Do not Further, Mounjaro improved other measures such as blood pressure levels and the amount of fat in the blood. Has anyone with OptumRX and UHC had success with enbold WITHOUT Type 2 diabetes? I have previously been on trulicity for insulin resistance, PCOS, and metabolic disorder but that PA got denied from my endocrinologist in January, I had a different telehealth platform get a PA for mounjaro denied last week. My So if you have no insurance currently, you cannot use the savings card. CVS messaged me saying “Rx is pending insurance approval” on 6/20. The combination of these medications can help: * Lower blood sugar Buy Mounjaro weight loss injections online in the UK and achieve up to 20% body weight loss. “In early 2023, I walked up to refill my Ozempic and overheard a woman being told her Wegovy was out of stock indefinitely. My experience has been that the weight loss has been slower but it is happening, I’ve lost 10 lbs in 2 months when many have lost 10 lbs in a couple of weeks. I requested my PCP to prescribe me Mounjaro (due to PCOS, no T2D diagnosis) on 6/20. I've seen some prior authorization forms for Mounjaro and it seems they only cover T2D. If you have retinopathy - a The teledoc and my PCP happened to both get PA requests in on the same day and after three days, the teledoc’s request was outright denied while the PCP’s request has been in the first review phase for five days. We are requesting that you reassess your recent denial of Mounjaro coverage. I've been on Mounjaro since September 1st of this year. Thank you! Sadly, my PA was denied today due to Mounjaro being excluded by my plan. May 2024: Mounjaro 2. Does anyone know what happens to Mounjaro if it gets too warm? Does it become dangerous or just less effective or inert? I had 6 pens in the refrigerator. Combining Jardiance and Mounjaro When used together, Jardiance and Mounjaro can complement each other's actions and provide enhanced benefits for individuals with type 2 diabetes. I went to a different Walgreens, and they seemed to know about the process, but when I went to pick it up they Store MOUNJARO in a refrigerator (2°C - 8°C). So far my pharmacy has over ridden the PA because we know MJ was not on my formulary. Being on Medicaid means that I'm out of luck with using the savings card. Submitted a prior authorization with labs etc, and was approved by insurance. Now, I'm not quite as concerned as I initially was. That’s ok, though, since this is when the coupon comes in! No, they kept refusing to fill it, even though the coupon has been loaded to my file and I’ve explained the process to them. Sure enough, 3 months later, CVS was out of Ozempic. Mounjaro is not approved as a weight loss medication, but it may help you lose weight if you have type 2 diabetes. I work for a small start up and they cover my plan 100% and it is a great plan otherwise. Each plan is widely different. If these medications are mentioned and you have never tried these medications, or have not tried the medications within the last few years, you may have been denied due to step Insurance Denied Mounjaro with T2 Diagnosis . (It was inside the boxes and the Also note some pharmacies require that you have a denied PA on file before they will apply the coupon, so you may need to have your doctor submit one, even if you know it will be denied. 5 mg up to as high as 15 mg over 6 months to give Mounjaro, also known as tirzepatide, is a medication that has gained popularity for treating type 2 diabetes and aiding in weight loss. MONTHLY AND ANNUAL MAXIMUM SAVINGS: For patients with commercial insurance coverage for Mounjaro: You must have commercial insurance that covers Mounjaro ® (tirzepatide) and a prescription consistent with FDA-approved product labeling to pay as little as $25 for a 1-month, 2-month, or 3-month prescription fill of Mounjaro. If you are not eligible for the Mounjaro Savings Program, then you may have to pay close to the list price shown above, plus any additional pharmacy charges depending on where you purchase Posted by u/MeeShell86 - No votes and 27 comments Same! I just started 7. While we’re hopeful that many more employers will jump onboard, However, as the body gets used to the effect of Mounjaro, the energy levels become stable, allowing the side effects to subside. I get these letters from Prime Therapeutics saying that Wegovy is excluded from my current benefit plan. My rx has been at Walmart since I started. In response, manufacturer Eli Lilly spent billions ramping up production and now, according to the If you are denied coverage for Ozempic, Mounjaro, Wegovy or Zepbound, Honest Care can help fight your denial by submitting an ‘appeal’ to your insurance. I have read about people getting Mounjaro approved Mounjaro Prior Authorization Process Tips Indication and Select Safety Information Indication: Mounjaro is indicated as an adjunct to diet and exercise to improve glycemic control in adults I have an old coupon codeworked GREAT until this week. For patients with commercial drug insurance coverage for Mounjaro: You must have commercial drug insurance that covers Mounjaro ® (tirzepatide) and a prescription for an approved use consistent with FDA-approved product labeling to pay as little as $25 for a 1-month, 2-month, or 3-month prescription fill of Mounjaro. • For more information about the MOUNJARO Pen, visit our website at www. My ins does not cover. 5 mg. It wasn’t added to most formularies until much later. Mounjaro is a once-weekly injectable prescription medicine to improve blood sugar (glucose) in adults with type 2 diabetes mellitus. So I am paying $550 a month. Wegovy was straight out denied because it is not in their formulary. Still jumps quickly with movement but not much higher than normal. Yay! Did anybody have issues using the $25 coupon? I have commercial insurance and it's definitely not going to cover Mounjaro. I have no idea what to do now, I’ve been basically told become a full diabetic and you can get a medication to lower your a1c after it’s too late. Had to advocate for myself and complete my own PA denial process. Once back in the refrigerator, you can use any of the pens until the expiration date marked on the individual Mounjaro, the brand name for the drug tirzepatide, is becoming an increasingly popular choice for people looking to lose weight. They are required to explain that to you when they deny coverage, and based on For patients with commercial drug insurance who do not have coverage for Mounjaro through their commercial drug insurance: Offer good until 06/30/2023 for up to 12 fills or whichever comes first. I honestly didn't know what my options were. Diet and exercise alone do not work for me. 5 mg, unless a patient is being switched from another GLP1 agonist such as Ozempic (in which case their provider will describe the dose conversion as Questions, experiences and accomplishments related to Mounjaro and Zepbound prescription medications. At the end of that you may still be denied. Resources for your patients. in my case, Mounjaro has been approved. But as Log on to your insurer or prescription drug coverage provider’s website and find out WHY your PA was denied. You should also • If you have questions or problems with your MOUNJARO Pen, contact Lilly at 1-800-Lilly-Rx (1-800-545-5979) or call your healthcare provider. Mounjaro, or tirzepatide, makes you feel fuller so you eat less. While less common, some people might experience an allergic reaction while taking Mounjaro (characterised by symptoms like skin rash, itchiness, and flushing). This letter will include your policy details, specific decision you disagree with, If you are denied coverage for Ozempic, Mounjaro, Wegovy or Zepbound, Honest Care can help fight your denial by submitting an ‘appeal’ to your insurance. My Push provider wrote a PA that was denied (which we expected). 3) my free insulin numbers have been so high I should have had diabetic numbers. 0141 774 5023 [email protected] These figures have been achieved by patients who have maintained on the highest strength of Mounjaro, which is the 15mg strength. So then the saving card kicks in and it was $25. A study from September 2023 found that 69% of people who were denied coverage by their insurance didn’t know they could A diabetes medicine dubbed the "King Kong" of weight loss jabs has been approved in the UK, external for treating obesity. If your Mounjaro prior authorization was denied due to the drug not being on your plan’s formulary, it means that your pharmacy benefit manager has chosen not to offer coverage of the medication. 5 = T2D. I went from no blankets/sweating at night to sleeping with a hoodie and blankets. Walmart does seem to be the most coupon friendly, based on experiences shared here, so that was a good call to transfer your Rx there. My a1c was 8. The pharmacist says that the card can only be used in conjunction with insurance and now my insurance has denied my mounjaro. Mounjaro is a prescription medication used to help manage blood sugar levels in adults with type 2 diabetes. We went out of town and had our house fumigated. One of the most common side effects of Mounjaro is diarrhea. I honestly don’t care because as you know it’s pretty much impossible to lose weight with Hashimotos. Look for sections related to prescription drugs and see if Mounjaro is mentioned. I adapted. My a1c is now 5. I checked the security cam. The European Medicines Agency therefore decided that Mounjaro’s benefits are greater than its risks and it can be authorised for use in the EU. Allergic reactions: Like most medications, Mounjaro may prompt an allergic reaction that could become severe, including trouble breathing, rash, hives, and swelling of the face or throat. Anyone had this happen ? I found out today the manufacturer of mounjaro has halted all coupons unless it's to fill prescription for type Is there anything I can do by calling my insurance carrier or notifying my doctor to help continue with Mounjaro rather then go "cold turkey" and not be able to be on it any longer? I am on 10 mg now. Another medication, Zepbound (tirzepatide), was created by the manufacturer of Mounjaro, Eli Lilly, under a new name for weight loss purposes. My pharmacy called me today to tell me that I can no longer get the medication at all because I don’t have type 2 diabetes. You should be getting a denial letter in the mail. Locked post. 🤣 Reply reply I am recovering from cancer, one of the bad side effects from my cancer was uncontrolled sugars of 600+. In 2 months I will have used the last of my Mounjaro pens and I'll start back on Rybelsus, which I have been ordering from Canada--not wanting to have my medicine get stuck in a holiday shipping crush or anything like that! I’ve been on Mounjaro since June for weightloss, prescribed by my PCP. Mounjaro is available for weight management as a pre-filled injection pen filled with 2. A community exclusively for type 2 diabetics using Mounjaro, Ozempic, or some of the other drugs that were created for type two diabetes, but increasingly being used for weight loss. Changes with copay card went into effect on October 1 where new patients have to check a box certifying that they have diabetes. Chelsea Handler admitted during a January 2023 episode of A diabetes medicine dubbed the "King Kong" of weight loss jabs has been approved in the UK, external for treating obesity. I started at 5mg and am currently on 10. It's been over 18 months and my diet hasn't changed. She did, and the Prior Authorization process has been going on for nearly two weeks now. I’m supposed to get my denial letter in the mail saying I was denied because Mounjaro is provided for TD2. If you have insurance, you typically won’t pay the list price for Mounjaro. New. So no approval from insurance equals me not being able to use my savings card. i have been on mounjaro the past 2 months, and lost 10 lbs. 10 mg was probably my sweet spot but I still went up to 12. The reasoning for the denial of Mounjaro is “you must have a condition that is supported in compendia for the requested drug. It’s great, I tolerate it well and have lost almost 25 lbs. 5mg, 10mg, 12. Open comment sort options. Doctor has submitted PAs for both ozempic and mounjaro and both have been denied. Weight Loss. Ozempic and Wegovy are made from a compound called semaglutide, and Mounjaro contains a compound called tirzepatide. Starting weight was 242 and now I’m 168. The fumigators THREW OUT the Mounjaro. The dr office finally had to call as Cigna required a PA for Ozempic but wouldn’t allow them to submit one. Keep in mind that it is essential to pair There IS plenty of data that it can wear off sooner than 12 weeks AND a specialist (neurologist) was the one to request it. I think I slept 12 hrs! But hey that might work for others! Next she is calling in Ambien to try. com. If you are denied coverage for Ozempic, Mounjaro, Wegovy or Zepbound, document patients can use to advocate for themselves with their insurance to cover their medical costs even prior to being denied for a treatment. Old. I’m just happy that it’s actually helping and Mounjaro does not expire, go bad or require use within 21 days simply because it was temporarily unrefrigerated. “I am not on Ozempi. And I already had preexisting insomnia but now it’s much worse. Because of its efficacy, many people are interested in using Mounjaro for health management. That should be good enough for the insurance company. But here’s the catch: The FDA approved the weekly injection “for chronic weight Mounjaro is a prescription medication used to help manage blood sugar levels in adults with type 2 diabetes. Sorry - I had to open it up to find my original prompt: “Write a letter to Blue Cross Blue Shield of Illinois requesting an internal appeal and formulary exception to prescription of Mounjaro for treatment of Type 2 Diabetes and mention previous use of Metformin, Actos, and Ozempic, which caused severe intestinal symptoms and cite studies The list price of Mounjaro is $1,069. However, if more than 4 days have passed, skip the missed dose and continue your regular dosing schedule. Remarkably, this medication has I've been on MJ since Oct, 2022 with a copay of $25 for a month or 3 month supply. Now I am forced to get a second job because as I said earlier, my health and being able to watch my grandchildren grow up is the most important thing. That being said, r/Mounjaro is also not a kindergarten classroom, and posters will be expected to own a helmet and skin thicker than rice paper. PreAuth Denied :/ Insurance UPDATE: apparently they aren’t going to appeal it (doesn’t sound like my dr, I think it’s just the admin that deals with preauthorizations) so I made an appointment to discuss why. ) Reply reply Mounjaro Prior Authorization Denied - Amplus Solar. as my insurance doesn’t cover it. I was floored. The GIP in Mounjaro has been an absolute game changer for me. So after the insurance on my ex-husband bcbs of Michigan covered the cost of 3600 plus 769 discount I was left to pay 475 co payment, and I looked into my CVS app. (Coupon posts muted in Tirzepatide has also been linked to significant weight loss. I appealed it and won and went back on 5mg Mounjaro in 2/23. During this adjustment phase, you may still experience hunger. super sad face. If you have been denied coverage by Mounjaro, a leading healthcare insurance company, you may feel like you have hit a roadblock in accessing the healthcare services you need. So, I was able to finally get everything settled. Whether your I had half of my thyroid taken out about 8 years ago and have been on 112 of synthroid. We are working on drafting an appeal letter now with cited studies and have even enlisted the help of ChatGPT in the crafting of the If you are denied coverage of Mounjaro or Zepbound, your health insurance company is required to put the the reason for it’s denial in writing. The side effects of Mounjaro are manageable and its safety will continue to be monitored. At the beginning of May, my PCP sent a prescription for Mounjaro and it required a prior authorization and it was denied (my diagnosis was hyperglycemia). Mounjaro is an FDA-approved medicine used to improve blood sugar (glucose) levels in adults with type 2 diabetes mellitus when used together with diet and exercise. 5mg. Month is defined as I have been on Mounjaro for two months now, when I went to get my third month my insurance is now denying it and the pharmacy I use (Walmart) says as of Oct. Tina Straw of Ohio told ABC News she chose to use a compounding pharmacy to obtain a medication for weight loss. As medications like Ozempic, Wegovy and Mounjaro used by some for weight If a prescription has been denied by your insurance, your prescribing physician may be able to reach out to ask why and appeal the decision. My insurance has been covering MJ since December but now I’m suddenly being denied with no change in employment. If you’ve been denied coverage for Zepbound or Wegovy, it’s possible that your denial due is due a weight loss plan exclusion. I gag constantly at the thought of food. A diabetes medicine dubbed the "King Kong" of weight loss jabs has been approved in the UK, external for treating obesity. Telehealth company Ro built a free Tirzepatide is an antidiabetic medication used for the treatment of type 2 diabetes [10] [13] [14] [15] and for weight loss. . If you take Mounjaro for this reason, you may have to pay out of pocket. If you have insurance that does not cover the cost of Mounjaro, does not include Mounjaro on the formulary, or a PA that has been denied by your insurance, you can use the savings card. My last employer, I had to pay $580 Now, if you're about to start taking once-weekly Mounjaro, you've probably been trying to get those A1C numbers down, like me. (I’ve never been on a dose higher than 2. It should be used along with diet and exercise. I went to the 5mg dose as it was the equivalent to my Ozempic dose and had zero side effects. I called and asked why it was denied, I was told that I had to have a diagnosis of type 2 diabetes. Ironically it wasn’t until my dr tried to submit a PA for Ozempic after getting denied for the Mounjaro. Over the last two weeks I have been on the phone with multiple walgreens and my insurance multiple times. It is unknown Learn about the dosages of Mounjaro for treating type 2 diabetes. Was last on 7. Denied. When I got my prescription sent in for my August fill, my insurance requested a PA, which has happened before but always been approved until this most recent If your insurance denied coverage for Ozempic, Mounjaro, Wegovy or Zepbound, you have the legal right to ask your insurance to reconsider the coverage denial by sending an ‘appeal’. The price you pay for Mounjaro can vary depending on various factors, including: Getting Started Video. As of Oct they have denied 2 PA's sent in from my Dr stating this medication is only covered for Type 2 when I called and spoke to someone in the PA department they keep telling me that this medication has ONLY been covered for Type 2 but when I asked them to review Ozempic has become a hot topic when it comes to weight loss — with some stars confirming they have used the drug while others denied it. A study from September 2023 found that 69% of people who were denied coverage by their insurance didn’t know they could There have been issues with Mounjaro availability with drug shortages for some strengths due to increase for the demand. Do I call my doctor and have them send rx order to Walmart and then present them with the $25 card? Despite these setbacks, my doctor attempted to secure PA for other medications like Wegovy, Saxenda, and Qsymia, but all requests were denied. mounjaro. Its causing me racing heart. The PA will likely be denied the first time for sure. While Mounjaro is generally well-tolerated, like any medication, it carries potential side effects, which should be discussed with your healthcare provider. So, maybe I'll go that route with Mounjaro, get it denied and then use the card. I heard word of mouth to try Costco and that kept my prescription filled through early 2024. The rep at Navitus was super nice and trying to offer suggestions as well. 4% of their starting weight; those taking 15 mg lost 22. This is why I’m excited about Mounjaro being available in Canada - in vials. Albeit, I will still be discussing with with my gyno at my forthcoming June appointment. i am working on paying my high insurance deductible with getting the mounjaro but it will be worth Hi guys! As like most of you, I’m fighting the toughest battle of being on this medication, and that’s obtaining the darn thing! With that being said, I’ve been impatiently waiting to hear back from my insurance company about my prior authorization and had called into check the status - to which I received a really great response, I’ve been approved and it’s sent to my pharmacy! Then, you actually start taking your pills regularly AND doing it at a time when it absorbs better and now, that crazy high dose is producing the blood tests results it should’ve been producing all along. She tried again with a diagnosis of pre-diabetes and it was also denied. That said, taking Mounjaro isn’t an instant win, and it's not a short-term solution. Again, check with your Medicare insurance company and get details re coverage, based on your diagnosis. I thought I would be covered until December 2023 because Mounjaro is listed on my insurance’s formulary. BCBS insisted that I try Metformin for 90 days. [TL:DR at the bottom] My stats: 38/F; 5'7"; SW: 207, GW: 150 would be awesome, but I'd settle for anything under 170; CW: 200. So I am a Nurse Practitioner and I had a patient become severely depressed and suicidal on Ozempic. This isn’t fair because it was helping me, so now it’s back to the Why Could PET Scans Be Denied by Insurance? As with most insurance denials, a PET scan is often denied by insurance due to cost. Another theory that attempts to explain fatigue in patients using Mounjaro is that this drug can disrupt the balance of hormones such as leptin and ghrelin involved in appetite regulation. We understand that the reason for your denial is [copy reason verbatim from the plan’s denial Question. A video guide on initiating treatment, dosing options and what to expect with side effects. I do not have T2D. WARNING: RISK OF THYROID C-CELL TUMORS. I did an expedited appeal of the denial (takes 48-72 hours for the entire process) but during that appeal a rep spoke with me and asked for what dosage it was for. Good luck! Zepbound and Mounjaro have been on the Food and Drug Administration's shortage list for months. And not having heart valve replacement surgery sounds Hi, I've been lurking heavily here since I started taking Mounjaro and reading through other people's experiences has really helped me. Then I received the message “We are contacting your Then insurance denied and I went on Ozempic from 12/22-1/23. And also, the numbers on the scale I know that struggle. This journey has not been easy. It's kind of a little worrisome cause I know my body needs nutrients so maybe skipping a shot or asking my Dr to go back down in the In addition to being a GLP-1 RA, Mounjaro is also a glucose-dependent insulinotropic polypeptide receptor agonist (GIP RA), and we’ll dive a little deeper into how that improves its efficacy below. That PA got denied due to mounjaro being a “plan exclusion unless type 2 diabetic. Due to the increasing need for GLP-1 medications such as Wegovy, Ozempic, Mounjaro and Zepbound, a reported 43% of employers plan to offer coverage in the near future. So yeah, this probably has zilch to do with Mounjaro and Mounjaro is a once-weekly injectable prescription medicine to improve blood sugar (glucose) in adults with type 2 diabetes mellitus. My first week I have notice a huge improvement in my BG, and lost 11lbs. The list price for Mounjaro is approximately $1,069 per fill. I have T2D and was denied a PA for MJ because my plan has even stricter requirements than those listed here. Doctors can still prescribe it for non-diabetics as a weight loss tool, but that’s up to their discretion. r/Mounjaro A chip A close button. RULE #2: Follow the Community Guidelines Guidelines for posting questions We currently specialize in insurance coverage denials for Ozempic, Mounjaro, Wegovy and Zepbound. If you have been denied Mounjaro coverage, you have alternative options include pursuing a different medication or looking for prescription savings and discount programs. Mounjaro and Wegovy have both been tested in clinical trials and proven to be effective weight loss medications. 3) Disrupts Hormones Leptin and Ghrelin. The medications work by slowing down the movement of food through the stomach As medications like Ozempic, Wegovy and Mounjaro used by some for weight loss experience a surge in popularity, they remain out of reach for many people. Here are some steps to help you through the process. A study from September 2023 found that 69% of people who were denied coverage by their insurance didn’t know they could Questions, experiences and accomplishments related to Mounjaro and Zepbound prescription medications. Navigating your insurance plan can be tricky, but it's essential to understand how to get Mounjaro covered. Eltex • It’s pretty commonly How could I? All I could do was sit and stare Disgusted with what I had allowed myself to become. I have worked in collaboration with pharmacies, drug manufacturers, insurance plans, and physician clinics specializing in endocrinology to submit prior authorizations and write appeals for denied prior 878 Likes, 346 Comments. 5mg, no coverage. Express scripts denied my Mounjaro script, if I have my pcp send it to Walmart instead can I use my savings card there or does the rejected claim still apply? Newly diagnosed with T2 diabetes, I tried my best this last year to control it with diet and exercise but my A1C was bad at 8. I have NO MORAL CONCERNS ABOUT THIS! Not even a tiny fraction. I started researching and sure enough it was noted in trials that some people had worsening depression. In June when my Dr prescribed it Caremark asked for a PA. To decide whether they will be changing my synthroid dosage. Also, my blood pressure is down and my cholesterol is normal. eknzzh eyxi etqi ufpnh bevsaf ogovi wxwdijbg cwlkica fctzh lofqpd