I’m seeing my internist soon and I’m hoping she will prescribe Zepbound for me. I have lipedema and there is some evidence that Zepbound has helped reduce inflammation. Both the physical therapist and occupational therapist feel it could be helpful. When I messaged my doctor she said we can talk about it but that she didn’t think insurance cover it as lipedema isn’t an approved condition. MyA1C is 5.7 and my BMI isn’t high enough.
Any helpful advice would be appreciated.
Although the information is scant, if you are on Medicare in July there will be something they are calling the bridge program. The weight loss drugs will be $50 a month.
If GLP-1 is for diabetes, those will still be subject to the formulary and your OOP cost will be the same.
I have no idea how this is going to work but if they go to $50 a month, we will be grateful.
3 Likes
I’m trying to figure out the Medicare thing. I’m 67 but not on it yet because my H has good insurance. However, that insurance just dropped me for this medicine because I reached normal BMI. So I’m trying to figure out whether to do maintenance with compound or Lilly Direct and how that will affect my chances of being able to access the Medicare program in a year or two. I’ll need my doctor to attest that I qualified when I began the meds. Which I did. But if I move to online compound, will that break the process since she won’t be the prescriber then. So maybe I should do Lilly Direct but that is so expensive!
Wish I was on Medicare now, the variables are driving me nuts.
1 Like
Today, I discovered a new effect of taking Zepbound for almost exactly a year. The weight loss and reduced inflammation are lovely, but apparently, my eyesight has also improved. My optometrist informs me that I need less correction than I did last year.
4 Likes
I gave my husband the article, and today he saw an ad for the Medicare program. His concern is if it ends in 18 months and if Lilly will allow him back on the direct program. I think I have him convinced that the savings will be worth it.
He is losing weight steadily, and I am seeing other benefits. His snoring is greatly reduced and he isn’t falling asleep in the middle of conversations or just inopportune times.
2 Likes
I’m trying to get my H to try it for these same reasons, but I’ve had no luck. Glad to hear it’s helped your H.
There is a lawsuit ongoing in our state that could potentially change how the weight loss drugs are covered by insurance.
2 Likes
I hope it’s ok to post this article. It’s the best one I’ve read about the GLP-1 bridge program that starts July 1. Only for Medicare patients and has some requirements but this article explains how it’s going to work.
My husband has one of the requirements, at first I thought he wasn’t going to.
2 Likes
I started out with qualifying conditions for the Medicare GLP-1 Bridge Program, but I’ve lost the weight and I’m just maintaining now. Does that mean I won’t qualify?
I’m not on Medicare yet, but will turn 65 in a little over 2 months. But spouse and I are both still working full time, and I’m currently covered under his insurance, which does cover my Wegovy prescription.
This is the quote I found.
“To qualify for the Medicare GLP-1 Bridge program, you must be at least 18 years old and meet one of these conditions when you first started GLP-1 treatment:”
So if you qualified when you started treatment then you should qualify even if you no longer do. That’s how I’m interpreting it. The key being first started
I’m also interpreting that you must be on Medicare and have either a supplement or advantage plan plus part D. The plan won’t go through part D but you must have it to qualify
Since the insurance you have does cover wegovy, that’s great! Some insurers aren’t
Thank you for the clarification. And while it’s great that my wegovy has been covered, it does mean it’s at risk if my husband retires and/or no longer has the same insurance.
I saw my doctor today and she wrote a prescription for self pay to LilyDirect. She said my insurance would not cover it. I’m hoping to lose a small amount of weight but mainly to reduce inflammation due to lipedema.
4 Likes
My (very mild) lipedema has improved, but I don’t know if it’s the Wegovy, rebounding, or both.
1 Like
I think I need that. I’ll ask my Dr when I go for my annual in September.
My doctor has just started me on Zepbound and I’m pretty excited. I have horrible food noise and I’ve lost a lot of weight on my own but just cannot take the constant struggle with the noise. So my question to you guys is what is the best day if any to do the shots. I have scanned the topics here to see if I could find much on when people take it but didn’t seem much. Does it matter what day you take it in terms of when you’re most likely to feel nauseous like 24 hours after! 48 hours? If you have any insights, let me know.
I do not feel any different after the shot. I have never experienced nausea or any other side effect. So it wouldn’t matter when I take it. As it happens, I do the shot on Sunday, for no particular reason. I’m taking Ozempic.
As I’ve mentioned before my husband started the wegovy pill. He takes it every morning when he wakes up
Says it’s helping with his inflammation. His brother wonders if some of that is my husband eating more clean carbs and not as much junk food. Could be both.
Husband is amazed how it stopped all the food noise. He eats at mealtime but has no inclination to snack.
The one thing my husband is noticing is that he needs to eat regularly and not have an empty stomach. A couple of times he waited too long to eat or did not eat much protein. Felt terrible afterwards. He needs to keep his protein intake up and needs to eat regularly.
1 Like
The first week I took my shot, I felt rough. Full body aches, like I’d been beat up from the inside. But after that, no nausea, no side-effects. So you may face them, people sure do. But you may not 
and that would be lovely. In terms of timing, what I’ve found is the medication is most evident for me (not very hungry, extended period of feeling full after a smaller amount of food, just don’t want to eat very much) for 24-72 hours post shot. So I take it on Friday mornings because the weekends were my “eating without thinking” time and it really cut down on that for me. While workweeks were easier to manage. But others really don’t want to lose out on their weekend dinners out with friends. So you have to decide what’s right for you. But if you find it’s not right, you can shift it over time by moving a day ahead or a day behind with each shot until you get to a day that’s optimal for you. Good luck!
Thank you! Great advice!
1 Like
I think a lot of it depends on what your daily schedule looks like. I’m a teacher, so was terrified to be stuck in class and have to deal with any digestive issues. I started the Friday heading into a vacation week so I could gauge how the bad side effects would be and if I’d need the weekends to recover. I ended up having NO side effects. Even on the highest dose.
1 Like