Insurance & Weight Loss Meds

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Specializes in M/S, LTC, Corrections, PDN & drug rehab.

So my husband is obese, at 6' he's 350+lbs. I have been trying to get him to eat healthy & exercise but being in the oil field & gone for 2 weeks at a time there's no way I can get him to exercise or control what he's eating when he's gone. He wasn't always over weight.

As a teenager he was in shape & as an adult he was too. But when we got together we developed bad eating habits which got worse when I got pregnant. We both gained over 100lbs. I lost the weight after I had our son, he however hasn't stopped. Of course it's easier for me since I'm a stay at home mom. But he still eats garbage & drinks his calories. Plus he doesn't exercise when he comes home.

So I finally got my husband to see a doctor & to no one's surprise he is pre-diabetic & has high blood pressure. I guess that shocked him because he changed his eating habits, starting walking when he could when he was at work & said he would exercise with me when he came home.

Then the doctor put him on weight loss meds. First came Contrave, it worked GREAT! He ate so much less & lost weight. But he slept all the time and at a price tag of $200-$300 a bottle. It was expensive! But to me, I felt it was worth it. But my husband started to hate feeling tired all the time, I don't blame him. So he went back to the doctor & asked for new medication.

That's when she prescribed Saxenda and the insurance didn't even cover that! So at an even higher price tag of $1,000 a pop I said no way! So with another appointment coming up I'm hoping maybe there is another medication he can get that might be covered. But at this rate I'm not too hopeful.

I just have to wonder, why? Why doesn't the insurance company cover weight loss meds? He needs it, he is clinically obese. It's not like he's taking it to lose 20-30lbs. If he loses the weight his blood pressure will go down & he won't be pre-diabetic. I'm also thinking it would be cheaper for him to get gastric bypass ($1,200) than spend $200-$300/month on pills. Isn't that ridiculous? Thanks insurance companies & your horrible, backwards thinking!

Shouldn't we be trying to keep people *out* of the hospital? Prevent people from having surgeries? Lower the rates of comorbities? How is having to pay extremes for weight loss medications helping that?

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Specializes in AGNP.

Have you called your insurance and find out what they do cover or look in the formulary?

Contrave is a combo pill and Saxenda is an injection so your insurance may require other medications to be tried first before they will cover those. Or they may not cover obesity medications at all. Some insurances require you to do a certain amount of time with weight watchers (that they pay for) before they will cover further therapies

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Specializes in M/S, LTC, Corrections, PDN & drug rehab.
Have you called your insurance and find out what they do cover or look in the formulary?

Contrave is a combo pill and Saxenda is an injection so your insurance may require other medications to be tried first before they will cover those. Or they may not cover obesity medications at all. Some insurances require you to do a certain amount of time with weight watchers (that they pay for) before they will cover further therapies

Well with him being in the oil field, he doesn't have time to do WW. We need to do what works for him.

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Specializes in AGNP.
Well with him being in the oil field, he doesn't have time to do WW. We need to do what works for him.

I understand that but unfortunately insurance companies don't care so if they have that requirement they won't pay for any meds until it is completed. You have to figure out what rules they have or what hoops they make people jump through

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Specializes in M/S, LTC, Corrections, PDN & drug rehab.
I understand that but unfortunately insurance companies don't care so if they have that requirement they won't pay for any meds until it is completed. You have to figure out what rules they have or what hoops they make people jump through

That's what blows the most. I just want him to be healthy. It shouldn't have to be like this to get him to a healthy BMI. It shouldn't cost an arm & a leg to get their. Not everyone can go to WW or do those things because of jobs or whatever commitments. I guess I'll have to talk to our insurance & find out what we have to do. It just seems ridiculous to me.

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I believe that Weight Watchers offers an on-line option now specifically for people whose jobs or location don't allow them to attend meetings.

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Specializes in M/S, LTC, Corrections, PDN & drug rehab.
I believe that Weight Watchers offers an on-line option now specifically for people whose jobs or location don't allow them to attend meetings.

Thank you. I'll e-mail our insurance & see what we hoops we have to jump through. I'm just so nervous for him, his family health history is terrible. So I want him healthy. Thanks everyone!

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I would like to know what the heck is in that $1000 pill! And you would think the insurance company would jump on board with the weight loss pill, seeing as there is a whole host of expensive and dangerous health problems that can arise from obesity.

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Specializes in M/S, LTC, Corrections, PDN & drug rehab.
I would like to know what the heck is in that $1000 pill! And you would think the insurance company would jump on board with the weight loss pill, seeing as there is a whole host of expensive and dangerous health problems that can arise from obesity.

Lol. That was a shot which is probably why is was so expensive. But I totally agree with everything you just said!!!

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Specializes in Clinical Research, Outpt Women's Health.

Be careful. Fen - phen worked great, but later they discovered it caused all those heart issues. He cannot be on meds forever so he must figure out some type of doable lifestyle change. Even the surgical procedures can be negated if eating habits don't change.

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Specializes in M/S, LTC, Corrections, PDN & drug rehab.
Be careful. Fen - phen worked great, but later they discovered it caused all those heart issues. He cannot be on meds forever so he must figure out some type of doable lifestyle change. Even the surgical procedures can be negated if eating habits don't change.

I've told him everything you just said. Sometimes it's like talking to a brick wall.

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Specializes in Pedi.
I would like to know what the heck is in that $1000 pill! And you would think the insurance company would jump on board with the weight loss pill, seeing as there is a whole host of expensive and dangerous health problems that can arise from obesity.

Do not waste your time trying to make sense of insurance companies' decisions. It's an impossible task. I had a patient at my last job who had a serious psychiatric illness. He had been stable for many years on a long acting injectable medication given q 2 weeks. It needed to be reconstituted and a fractional dose given and neither he nor his mother were capable of doing it. So he needed 1 nursing visit every other week, 26 visits per year. His insurance company fought this tooth and nail. They felt that, because he was stable, he should be taken off the med that was keeping him stable. He had failed every oral med out there but they cared not. They wanted him off the med that was keeping him out of the hospital. Without he, his condition undoubtedly would have deteriorated. An entire year of this treatment costs a fraction of what a single hospitalization would have cost but they didn't see it that way. I hate managed care.

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