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It was infuriating trying to get Wegovy via insurance. My doctor made three appeals, all denied. Out of pocket it wouldve been $1600/mo. Ive been getting semagl

It was infuriating trying to get Wegovy via insurance. My doctor made three appeals, all denied. Out of pocket it wouldve been $1600/mo. Ive been getting semaglutide from compounding pharmacies for the last year and half for $149-$200. I have lost 97lbs, come back to running 30 miles a week after several major knee injuries made even a mile jog a multiday recovery effort. I absolutely get the regulatory stance but the name brands are absolutely unaffordable.

bdcravens 8mo ago
Do you have diabetes, heart disease, or another condition necessitating a GLP-1?
- SOLAR_FIELDS 8mo ago
  Why is obesity not considered a necessitating condition? It often carries the comorbidities you just mentioned. Should not exclude people just because they haven’t had these specific health problems (yet) but will eventually have them.
  - bdcravens 8mo ago
    While I tend to agree, insurance companies don't see it that way. They need a doctor to indicate a necessity to treat a condition, as opposed to it being the easiest way to treat it. For example, I have to take digestive enzymes to digest my food (pancreatic insufficiency). For someone with an unusually high metabolism, they would also give them a leg up on gaining weight, even though there are other approaches to gaining that weight. However in many cases, the insurance company wouldn't cover their prescription when they will mine.
    - SOLAR_FIELDS 8mo ago
      As always it’s insurance nonsense. If incentives were aligned insurance companies would be lining up out the door to give this to obese people because they (the insurance companies) would eventually be on the hook for paying for the care of the conditions you just mentioned. It is very well demonstrated in literature that obese people have a much higher occurrence of these conditions than non obese people. But the system is not set up with aligned incentives
  - SpicyLemonZest 8mo ago
    The problem is that if it's just about obesity, you have to prove that cheaper treatments such as diet and exercise didn't work. That's not impossible to do, but it's hard and annoying even for people who really were trying. My doctor told me that you basically have to keep a detailed journal of your weight loss efforts for months on end. Are GLP-1s so much more effective that we should make an exception to the general principle, maximizing healthcare resources by providing the cheapest effective treatment? I kinda think so, but I have a conflict of interest, and I can understand why others might think that money is better spent elsewhere.
- notesinthefield 8mo ago
  I was 347lbs at the time. Wasnt a diabetic (nor pre-diabetic) no heart disease, blood pressure or really anything other than my weight. Prior to then Id had two massive bouts of weight loss at 50-100lbs so I know what it takes. Id tried but this last time without meds was extremely hard. You cant do much in the way of productive exercise when both your shoulders need replacement at 30 and between two knees have an ACL tear and two MCL tears. To top it off I had wildly out of whack hormones.
- gsk22 8mo ago
  I think you would be hard-pressed to find any human who has been 100 pounds overweight for any amount of time that doesn't have an obesity-related comorbidity. Hypertension, sleep apnea, high cholesterol, etc are all common in the general population and exacerbated or even caused by the physical and lifestyle conditions that beget obesity.
Auracle 8mo ago
They’re down to hundreds a month, now, with a coupon. I can’t say I disagree with insurance not being willing to pay those costs (apart from diabetes patients etc.). I bet a large part of the reason you can get the name brands cheaper now is because they did the math they’d make more that way than they could squeeze out of insurance companies. Also, on a personal level it rubs me the wrong way to have my insurance premiums go towards something that people could just do themselves, from something they did to themselves. I know many will disagree, of course, and there are other examples (say, lung cancer treatments) that are similar.
- sowbug 8mo ago
  People with high blood pressure could just try harder to relax, too.
- toomuchtodo 8mo ago
  > Also, on a personal level it rubs me the wrong way to have my insurance premiums go towards something that people could just do themselves, from something they did to themselves. I know many will disagree, of course, and there are other examples (say, lung cancer treatments) that are similar. Our Obsession With Personal Responsibility Is Making Us Sick - https://jacobin.com/2026/02/health-inequality-individual-responsibility-class https://jacobin.com/2026/02/health-inequality-individual-res... - February 6th, 2026
- cogman10 8mo ago
  > lung cancer treatments A fairly large portion of lung cancer patients didn't "do it to themselves" (about 20% and rising). It remains to be seen how vaping impacts lung cancer, I don't like the idea of finding reasons to penalize people for predicable life decisions that lead to treatment needs. Insurance companies have a lot of resources to make those predictions and if unshackled they aren't afraid of using them. Making construction workers, miners, or truck drivers pay more (or be denied outright) for insurance because their job has negative health effects would be bad for society.
  - junofan 8mo ago
burnt-resistor 8mo ago
I was receiving compounded Semaglutide (Wegovy generic) from Victory Pharmacy, a brick & mortar compounding pharmacy, in Austin for $150/mo, then $200/mo, and finally I stopped when it reached $250/mo. I have SSDI and Medicare but it wasn't covered and it's still not covered for pharmacologically-induced obesity or weight gain. If I developed diabetes, then it would be covered as Ozempic (lower dose). I'm having to go without because of bureaucratic gatekeeping and discrimination and because of opportunists cash grabs by pharmaceutical companies' price gouging.

bdcravens 8mo ago

Do you have diabetes, heart disease, or another condition necessitating a GLP-1?

SOLAR_FIELDS 8mo ago
Why is obesity not considered a necessitating condition? It often carries the comorbidities you just mentioned. Should not exclude people just because they haven’t had these specific health problems (yet) but will eventually have them.
- bdcravens 8mo ago
  While I tend to agree, insurance companies don't see it that way. They need a doctor to indicate a necessity to treat a condition, as opposed to it being the easiest way to treat it. For example, I have to take digestive enzymes to digest my food (pancreatic insufficiency). For someone with an unusually high metabolism, they would also give them a leg up on gaining weight, even though there are other approaches to gaining that weight. However in many cases, the insurance company wouldn't cover their prescription when they will mine.
  - SOLAR_FIELDS 8mo ago
    As always it’s insurance nonsense. If incentives were aligned insurance companies would be lining up out the door to give this to obese people because they (the insurance companies) would eventually be on the hook for paying for the care of the conditions you just mentioned. It is very well demonstrated in literature that obese people have a much higher occurrence of these conditions than non obese people. But the system is not set up with aligned incentives
- SpicyLemonZest 8mo ago
  The problem is that if it's just about obesity, you have to prove that cheaper treatments such as diet and exercise didn't work. That's not impossible to do, but it's hard and annoying even for people who really were trying. My doctor told me that you basically have to keep a detailed journal of your weight loss efforts for months on end. Are GLP-1s so much more effective that we should make an exception to the general principle, maximizing healthcare resources by providing the cheapest effective treatment? I kinda think so, but I have a conflict of interest, and I can understand why others might think that money is better spent elsewhere.
notesinthefield 8mo ago
I was 347lbs at the time. Wasnt a diabetic (nor pre-diabetic) no heart disease, blood pressure or really anything other than my weight. Prior to then Id had two massive bouts of weight loss at 50-100lbs so I know what it takes. Id tried but this last time without meds was extremely hard. You cant do much in the way of productive exercise when both your shoulders need replacement at 30 and between two knees have an ACL tear and two MCL tears. To top it off I had wildly out of whack hormones.
gsk22 8mo ago
I think you would be hard-pressed to find any human who has been 100 pounds overweight for any amount of time that doesn't have an obesity-related comorbidity. Hypertension, sleep apnea, high cholesterol, etc are all common in the general population and exacerbated or even caused by the physical and lifestyle conditions that beget obesity.

Auracle 8mo ago

They’re down to hundreds a month, now, with a coupon. I can’t say I disagree with insurance not being willing to pay those costs (apart from diabetes patients etc.). I bet a large part of the reason you can get the name brands cheaper now is because they did the math they’d make more that way than they could squeeze out of insurance companies. Also, on a personal level it rubs me the wrong way to have my insurance premiums go towards something that people could just do themselves, from something they did to themselves. I know many will disagree, of course, and there are other examples (say, lung cancer treatments) that are similar.

sowbug 8mo ago
People with high blood pressure could just try harder to relax, too.
toomuchtodo 8mo ago
> Also, on a personal level it rubs me the wrong way to have my insurance premiums go towards something that people could just do themselves, from something they did to themselves. I know many will disagree, of course, and there are other examples (say, lung cancer treatments) that are similar. Our Obsession With Personal Responsibility Is Making Us Sick - https://jacobin.com/2026/02/health-inequality-individual-responsibility-class https://jacobin.com/2026/02/health-inequality-individual-res... - February 6th, 2026
cogman10 8mo ago
> lung cancer treatments A fairly large portion of lung cancer patients didn't "do it to themselves" (about 20% and rising). It remains to be seen how vaping impacts lung cancer, I don't like the idea of finding reasons to penalize people for predicable life decisions that lead to treatment needs. Insurance companies have a lot of resources to make those predictions and if unshackled they aren't afraid of using them. Making construction workers, miners, or truck drivers pay more (or be denied outright) for insurance because their job has negative health effects would be bad for society.
- junofan 8mo ago

burnt-resistor 8mo ago

I was receiving compounded Semaglutide (Wegovy generic) from Victory Pharmacy, a brick & mortar compounding pharmacy, in Austin for $150/mo, then $200/mo, and finally I stopped when it reached $250/mo. I have SSDI and Medicare but it wasn't covered and it's still not covered for pharmacologically-induced obesity or weight gain. If I developed diabetes, then it would be covered as Ozempic (lower dose). I'm having to go without because of bureaucratic gatekeeping and discrimination and because of opportunists cash grabs by pharmaceutical companies' price gouging.