Understanding Recent GLP-1 News
By: Catalyst Physician Group Staff
Over the past weeks, we have heard from many patients about the recent news concerning GLP-1 medications. Continue reading to understand what it all means and what you can do.
In short: The US Food and Drug Administration (FDA) announced the nationwide shortages of GLP-1 medications, including popular brands like Ozempic, Wegovy, and Mounjaro, have been resolved. As a result, the FDA will no longer allow copy-cat versions of commercially-available GLP-1 medications to be compounded, and legal action may be taken against violators.
What This Means for Patients
- Availability does not guarantee coverage: Although these medications are now more readily available, they are not automatically covered by insurance for all patients.
- Insurance requirements apply: Many insurance plans require specific medical criteria to be met before covering GLP-1 medications. This can include a diagnosis of type 2 diabetes, a specific body mass index (BMI), and/or other comorbidities like sleep apnea.
- Insurance Authorizations will be denied if criteria are not met: Insurance companies will not approve authorization requests for patients who do not meet their insurance company’s criteria. Submitting authorization requests unnecessarily may delay access to medications that are covered for those patients.
- Compounded GLP-1 medications will be restricted: Patients will not have access to compounded GLP-1 medications in commercially available dosages. However, compounding may still occur for clinical needs, including in different strengths or if combined with extra ingredients. It is important to note that compounded medications are not FDA-approved, meaning their efficacy, safety, and consistency cannot be guaranteed.
What Can Patients Do?
- Contact your insurance provider: If you are taking or considering GLP-1 medications, ask your insurance company what specific criteria need to be met for coverage for weight loss or diabetes. This can help you understand whether you qualify or if alternative options should be explored.
- Explore the following resources:
- LillyDirect offers reduced cash pricing for Zepbound
- NovoCare offers insurance cost estimates and savings programs
- GoodRX helps patients find the lowest cash price across pharmacies
- Patient Assistance Programs:
We know these medications have become very popular and are beneficial for many patients. We will continue to monitor emerging news and regulations to ensure we bring you the latest, safest, and best tools for managing your health. Your health journey is our top priority, and we are here to support you.
