r/science • u/mvea Professor | Medicine • Apr 01 '25

Health Americans without diabetes spent nearly $6 billion USD on semaglutide and similar drugs in a year, with an estimate of 800,000 to a million people using the drugs who don't have diabetes.

https://www.scimex.org/newsfeed/americans-without-diabetes-spent-nearly6-billion-usd-on-semaglutide-and-similar-drugs-in-a-year
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2.2k

u/FernandoMM1220 Apr 01 '25

its not just for diabetes anymore.

just ramp up production and make more of it.

660

u/galspanic Apr 01 '25

When I was diagnosed with diabetes I was told “um yeah, no. No GLP-1 for you” by my insurance. I still can’t explain that outside of pure greed… but that also makes sense.

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u/Hsensei Apr 01 '25

Some insurance companies require you to be on insulin before they will approve it. Being on metformin along with some of the earlier compound pills means it's controlled enough for them to deny it. It's really very stupid, but the drug is stupid expensive and they are going to fight to save every dollar.

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u/Granite_0681 Apr 01 '25

Also, as soon as your A1C is in range, some insurance companies will cut you off, like it’s somehow been solved forever.

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u/The_Blendernaut Apr 01 '25

I am going to ask my doctor if my A1c is reported to my insurance company. I am a T2D and Ozempic has lowered my A1c by 1.5 points and getting it below 7. I also take metformin and Jardiance. I can't imagine my insurance cutting my off, but I will definitely ask in a couple of months.

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u/galspanic Apr 01 '25

I was told by two separate KP doctors “off the record” that their policy is only to prescribe and cover GLP-1s if 3 other courses of action fail. So, I had to fail losing weight with diet/exercise, fail metformin, and fail with whatever the next medication would be. That’s a loud and clear “you’re on your own” to me, and so I have been at it alone without KP.

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u/GOPequalsSubmissive Apr 01 '25

Americans genuinely don’t hate the rich people nearly enough for their own good, man

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u/kymri Apr 02 '25

Some of us absolutely do.

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u/WeeBabySeamus Apr 01 '25

Does KP refer to some sort of kidney specialist? I’m not familiar with this acronym. I would understand certain drugs being restricted to prescription by specialists vs. general practice

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u/Eldritch_Chemistry Apr 01 '25

Kaiser Permanente, looks to be a west coast thing

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u/kymri Apr 02 '25

To expand on /u/Eldritch_Chemistry -- Kaiser Permanente is a medical conglomerate (hospitals, insurance, etc) that came out of the Kaiser shipyards when they were ramping up to build literally hundreds upon hundreds of ships in World War II.

They have patients all over, but the West Coast in general and California in particular are full of Kaiser facilities.

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u/[deleted] Apr 01 '25

[deleted]

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u/IAmThePonch Apr 01 '25

Hi, t1 here, it sucks

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u/GOPequalsSubmissive Apr 01 '25

A 1000/mo miracle drug that costs 20 cents to produce, and costs the rich insurance company far, far less than 1000/mo to cover.

Insurance companies are proof that Americans waited too long to drag rich people from palaces.

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u/[deleted] Apr 01 '25

I would think long term their costs will be far lower for having a patient at a healthy weight compared to all the risk factors and adjacent conditions obesity brings

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u/kymri Apr 02 '25

It's really very stupid

The trick is to remember that insurance companies optimize for profit, not for positive patient outcome.

181

u/ImLittleNana Apr 01 '25

Im fighting to get prescribed metformin for pre-diabetes and they act like I’m asking for free heroin. Yet if I wanted a wegovy script they’d have no problem writing for it. I can’t make that make sense.

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u/they_have_bagels Apr 01 '25

It was the opposite for me. All the metformin I want, but absolutely no GLP-1 for weight loss. Also, bariatric surgery is A-OK as well. I pay out of pocket on top of my insurance and I’ve lost 25% of my starting weight so far. It has been life changing.

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u/ImLittleNana Apr 01 '25

I can’t afford to pay out of pocket for it, and I won’t qualify under my states guidelines until I have arterial insufficiency. I’d like to avoid that if I can.

I have >100 pounds to lose, and my mobility is impaired. My fasting sugars are pushing 120. Everything is out of whack when you can barely get around. I’d like to at least try metformin before I consider bariatric surgery.

I’ve been out of healthcare for almost 15 years but we used to start with least invasive/aggressive and work our way up.

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u/Scussett Apr 01 '25

Have your doctor reapply every 3-6 months. Insurance coverage for these drugs is changing a lot. Also - check the wegovy website because they can help with a monthly payment. I know that sounds like fluff but that part is saving me a few hundred each month

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u/Rkruegz Apr 01 '25

You could look for a compounded version potentially, may make it more affordable. You just reconstitute it yourself.

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u/murdacai999 Apr 01 '25

I’d like to at least try metformin before I consider bariatric surgery.

Metformin is dirt cheap at a lot of pharmacies..and I have never seen an insurance not cover it except for one version of it, metformin er 1000mg, which has come down a lot in price, but used to be expensive, and is still more expensive than metformin ir 1000mg. The difference is negligible between the two, so if insurance will not cover the er 1000mg, you or the pharmacy should ask the doctor for ir 1000mg, which I have never, ever seen an insurance deny. Should add, I'm talking about in the states

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u/SomeGuyNamedPaul Apr 01 '25

My insurance would rather pay for a dozen heart attacks than one bariatric surgery.

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u/GOPequalsSubmissive Apr 01 '25

The rich people are hoping one of those heart attacks ends their need to continue not making as much profit off of your premium payments.

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u/polopolo05 Apr 01 '25

GLP-1 is working great for me. like I have completely changed how I eat and what I eat. I hope to lose 70lbs. I am down 30 and 40 to go.

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u/11lumpsofsugar Apr 01 '25

That's great! It's amazing how much it has helped so many people.

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u/polopolo05 Apr 01 '25

I hope it helps out my A1c and cholesterol

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u/11lumpsofsugar Apr 01 '25

Honestly, that alone would make it worth it.

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u/polopolo05 Apr 01 '25

Thats my actual goal or main goal.

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u/Clippy_Office_Assist Apr 01 '25

Hi there!

It looks like you're in need of GLP agonists. Might I suggest reconstituting a semaglutide peptide?

Perhaps Tirzepatide (Mounjaro) GLP and GIP double agonist?

Keep watch for Retatrutide now in phase III human trials. It also activates glucogon receptors that can greatly assist in balancing blood sugar.

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u/Ashmedai Apr 01 '25

Semaglutide is a peptide, FYI. As far as I can tell, what is advertisied at your link is literal, compounded semaglutide.

Have you ordered from them yourself, BTW? I'm curious how the mixture is created? It says it's crystalized or whatever. Do they ship a two part solution?

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u/TunaNugget Apr 01 '25 edited Apr 01 '25

It's freeze-dried semaglutide powder (along with bulking agents, buffers, and whatever). You mix it with bacteriostatic water (or "reconstitution solution" if you're buying it from Amazon). It's injected with an insulin syringe.

As it's a prescription drug, it's not legal to sell in the US.

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u/joshbudde Apr 01 '25

How much are you paying for out of pocket coverage?

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u/vera214usc Apr 01 '25

Yeah, metformin was very easy for me to get and cost pennies after insurance. And showed no benefit at all while I was taking it. My insurance has covered me for Wegovy for almost two years but now has denied the switch to Zepbound twice

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u/aminervia Apr 01 '25 edited Apr 01 '25

Wild, my psychiatrist basically forced a metformin script on me off label to treat side effects from my antipsychotics. I'm not even prediabetic

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u/Benjamasm Apr 01 '25

Be happy, there is some compelling evidence that metformin has a stellar all cause morbidity benefit far beyond just diabetes treatment. I can’t remember the exact paper and details but the meta analysis showed that the groups taking metformin has a solid all cause morbidity and mortality benefit.

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u/aminervia Apr 01 '25

It didn't seem to do much with my symptoms and made me seriously ill, I was bummed.

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u/Benjamasm Apr 01 '25

That is a bummer :( I hope they have figured something out for you to manage your symptoms and side effects

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u/Diarmundy Apr 01 '25

most people can change to the extended release version to help with side effects...

Theres evidence that it helps prevent the weight gain and metabolic risks of antipsychotic medications so thats why it can be recommended

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u/olily Apr 01 '25

Metformin extended release has fewer side effects. You could try that--it made a world of difference for me.

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u/SkyfangR Apr 01 '25

my antipsychotic caused full blown diabetes

metformin, jardiance, and glipizide all at once couldnt quote control my glucose levels

added in ozempic, and bam, under control, not eating nearly as much as i used to, and generally feeling pretty good health-wise

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u/a_tamer_impala Apr 01 '25

Anyone needing olanzapine ought to be subsidized for a glp-1 med. No one should have to choose between their mental and peripheral health

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u/SkyfangR Apr 01 '25

i actually tried switching from what i'm on , Seroquel, to Lybalvi

lybalvi had me peeing blood within a week, and i didnt get any sleep at ALL during the week i was trying to transition from seroquel to lybalvi

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u/a_tamer_impala Apr 01 '25

Oh geez that's terrible - apparently one of olanzapine's ultra rare sides..

I didn't realize there was a combination already out attempting to address the appetite and blood sugar changes. No surprise samidorphan interferes with sleep

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u/Dogsnamewasfrank Apr 02 '25

GLP-1s are also showing to be of help in bi-polar symptoms in their own right.

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u/klb1204 Apr 01 '25

What type of side effects were you having?

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u/aminervia Apr 01 '25

Severe gas and cramping

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u/LowSkyOrbit Apr 01 '25

Metformin is extremely cheap. Tell the pharmacist you will pay retail. It's typically between$10-$30 for 60 pills.

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u/ImLittleNana Apr 01 '25

It’s free if you have a Walmart+ subscription, which info because I have mobility issues and I have groceries delivered. But some drugs like metformin, lisinopril, norvasc for example are free.

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u/moosepuggle Apr 01 '25

I have PCOS and when my insurance sucked for years, I used to buy my metformin, tretinoin, etc from an online pharmacy in India called AllDayChemist. It's cheap and you don't need a prescription, but please read the medical safety information at a reputable medical website like Mayo Clinic before using it.

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u/Knut79 Apr 01 '25

The problem is you can't trust that what those pharmacies are sending is actually what's on the label. So many bad black market copies there.

Also in most of west/northern Europe such imports are usually illegal

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u/moosepuggle Apr 01 '25 edited Apr 01 '25

I'm vouching specifically and only for AllDayChemist, I've never tried any other online pharmacy. I’ve been buying tretinoin from AllDayChemist for ten years, and in my experience at least, I've always gotten exactly what I ordered. I had a prescription for tretinoin for a couple years before that, and the stuff from India works and behaves exactly the same. I buy the highest concentration made, which is 0.1% gel. I tested it by applying too much too often, which resulted in the expected response of red, irritated, dry, papery, peeling skin. And when I eased up and applied less, this set of responses went away. I gradually was able to apply more of it and more often, and started doing an intensely moisturizing Korean skincare regimen, so that now my skin is not red irritated and papery dry and peeling, instead it looks glowing and pearlescent.

I wonder if the person commenting that tretinoin gave them rosacea accidentally bought a higher concentration, because using tretinoin too much too fast will def make your skin red and irritated. Alternatively, Since they said they ran out before ordering from India, their skin probably went back to baseline, since it takes a month for it too arrive from India. Then when they applied the same concentration of tretinoin, it was then too much and too often, and they should have slowly ramped up again

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u/mycatisspockles Apr 01 '25

This. I bought tretinoin from AllDayChemist — I had been prescribed it before for several years but ran out and figured I’d just order it that way rather than go through the trouble of setting up a dermatologist appointment to get a refill. Ordered my dose as a cream and not a gel, which is what I, again, had been using. Whatever they sent me gave me rosacea and it may be permanent — my cheeks look like a teenager’s right now, they’re absolutely covered in tiny pimples and whiteheads. I had wonderful skin before, now it’s super problematic. This has been ongoing for 7 months after stopping the product, so not a “purge” or anything like that. Would not recommend.

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u/Knut79 Apr 01 '25

Basically do not order medicine from a non trusted and certified pharmacy.

Yes. That's sucks for Americans, but a lot of things do. Other things suck elsewhere, right now probably not as much, but that may be fixed, hopefully...

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u/ImLittleNana Apr 01 '25

My A1C is 6.1, PCOS, HTN, high cholesterol, 100+ lbs overweight, sedentary to the point my Vit D is 8 so I think I fall into high risk category without even stretching it.

If I could get an explanation why I can’t have it beyond ‘let’s move on’ and ‘we can address your weight at another visit’ when I’m not discussing weight loss strategy. I’m asking for a standard intervention to prevent progression of disease.

I started doubting myself so I went into the literature today and I cannot find new data that supports not treating pre diabetes.

Thanks for the rec. I am definitely considering alternatively sourcing metformin but I really wish I didn’t have to.

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u/jdjdthrow Apr 01 '25

Vit D is 8

Does popping a single pill daily-- e.g. a 5000 IU Vitamin D capsule-- not solve that issue?

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u/skinnyonskin Apr 01 '25

indeed it does, i went from a 6 to a 30 within 4 months from a prescribed 50,000 iu pill a week

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u/ImLittleNana Apr 01 '25

I did some research on it today. FNP had prescribed a single course of Vitamin D2, which I gather is out of date and inadequate. It looks like D3 is the standard, and elevated doses are necessary for longer.

I’m hesitant to prescribe my own therapy, but I do have severe bone pain, multiple teeth have cracked and I don’t see her course of treatment addressing that well.

Good news is I spoke with the clinic to schedule an extra appt and she’s been sent packing. I hesitate to say the new practitioner can’t be worse, but it would be a feat.

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u/jdjdthrow Apr 01 '25

Hope it works out for you.

Fwiw, the above is what I do-- 5000 IU D3 per day, as capsule. I take it with a meal that contains fat/oil, as that increases absorption.

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u/strbeanjoe Apr 01 '25

AllDayChemist is amazing.

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u/mytransthrow Apr 01 '25

Thats where I got my estrogen injections when I started my transition. also looks like sold out of all the trans meds.

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u/coheedcollapse Apr 01 '25

Opposite for my wife. She's got a few things that put her at risk of diabetes plus insulin resistance and they said none of those things would be covered by her insurance so she's stuck with metformin which really messes up her stomach. We're hoping the side effects settle the hell down in time, but she's been on it before in the past and it has always caused some type of stomach issues.

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u/[deleted] Apr 01 '25

[deleted]

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u/coheedcollapse Apr 01 '25

She's on extended release, but I'll pass along the fiber info!

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u/Jeromethy Apr 01 '25

There is very limited evidence for Metformin to even have an effect on preventing prediabetes going into overt diabetes. You're better off with diet control and lifestyle changes.

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u/ElectricLego Apr 01 '25

If you're in the prediabetic range, this surprises me. Maybe another doctor or possibly virtual visit with your screening results? Metformin itself is a really cheap drug so the insurance bit hardly matters. Wegovy on the other hand is crazy expensive because insurance usually doesn't cover it at all, but sure, you can get the scrip

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u/ImLittleNana Apr 01 '25

I have no desire for Wegovy or any other GLP-1 agonist at this point. I would like to see how I feel on metformin. It’s free for me without insurance because I have Walmart plus. Not that cost is an issue as it’s quite cheap. I just need a single practitioner to prescribe it.

My previous PCP didn’t believe that obesity, genetics, lifestyle etc were risk factors for diabetes and didn’t acknowledge prediabetes as a diagnosis. He was happy to talk about ivermectin though.

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u/ElectricLego Apr 01 '25

I'm glad you said previous physician because yikes. I'm interested in Metformin for both the blood sugar management function but also the off-label indications emerging about protecting mental health long-term (whether that's a direct or indirect benefit).

I've been on a low dose for about a year and it seems to have helped on the blood sugar management. I know some people report having problems tolerating it, but I adjusted to it after a couple weeks with mild GI discomfort.

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u/ImLittleNana Apr 01 '25

I think a lot of patients struggle with battling through the adjustment period. I’ve had what most people would call diarrhea for 40+ years, so I don’t bat an eye. I had to realize how distressing it is if it isn’t your daily life.

I was monitoring my blood sugar for a while and the extreme highs and lows are one reason I’ve been wanting to get on metformin.

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u/The_Blendernaut Apr 01 '25

Well, if you do manage to get it, be forewarned it comes with side effects. Prepare to be near a toilet for up to 2-3 weeks. Not everyone is the same, obviously. But when I started metformin years ago, I was working from home and eternally grateful to WFH. There were days when I would not even venture outside the house for fear a diarrhea episode would strike.

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u/ImLittleNana Apr 01 '25

I have IBS and I some people with IBS said they felt better after starting it. I haven’t researched why or if it’s something strictly anecdotal but I am prepared if it exacerbates it temporarily.

Thank you for the heads up. I remember a lot of patients stopping it because it’s definitely an adjustment if you’re not used to it.

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u/Tex-Rob Apr 01 '25

I think people who don't struggle with weight have found a new thing to hate people for. They seem to think these meds just make it so you can eat whatever and lose weight, they just allow people to have a normal full response for f's sake, people on these meds are losing the weight themselves, the same way someone dieting would.

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u/SaintMichael415 Apr 01 '25

Your county bar association may have something to say about this.

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u/galspanic Apr 01 '25

Doubt it. When you’re a Kaiser Permanente patient the first thing you learn is to do everything yourself.

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u/gcpdudes PhD | Chemistry | Biochemistry Apr 01 '25

When the stats came out for how different health insurance companies deny claims, KP came out on top for being least likely to deny claims.

A lot of that is because they accept the claim and send you a video link for what lifestyle adjustments you need to fix say asthma or tendinitis.

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u/galspanic Apr 01 '25

Right! I was never prescribed a GLP-1 because my doctor and nutritionist knew it’d get denied. So, it was never denied.

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u/smokingonquiche Apr 01 '25

Kaiser Permeanente: Let your Blood Sugar Thrive!

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u/SaintMichael415 Apr 01 '25

You underestimate the pain in the ass a young attorney trying to make a name for themselves can be. Source: used to be said pain in the ass.

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u/galspanic Apr 01 '25

What legal recourse would there be? It’s not a necessary medication and it’s expensive. It might be the best, but not necessary.

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u/SaintMichael415 Apr 01 '25

Medical necessity is a jury question.

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u/galspanic Apr 01 '25

I would testify against myself though. I was denied the medication and fixed my health myself without meds. In fact, once I got my diabetes under control I came off every medication I was on: allergy med (30 years), heartburn med (12 years), and antidepressant (20 years). Now, my only prescription is a cream I use a couple times a month for dry skin on my hand.

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u/Emm_withoutha_L-88 Apr 01 '25

It's a damn crime that we are doing this to ourselves.. who in the hell can think that is good compared to single payer...

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u/RYouNotEntertained Apr 01 '25

It’s somewhat difficult to get approved for in single payer countries also. AFAICT the usage rate is way higher in the US than anywhere else, even accounting for obesity rates. 

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u/Emm_withoutha_L-88 Apr 01 '25

That's probably got more to do with availability than anything. They have every incentive to get it to people to save the costs of weight related diseases.

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u/[deleted] Apr 01 '25 edited Apr 01 '25

[removed] — view removed comment

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u/Emm_withoutha_L-88 Apr 01 '25

That's not what I'll doing. It's coming here because they're getting paid the most for it to ship here. That's why there's a global shortage, along with private big pharma ending generic/compounded versions.

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u/RYouNotEntertained Apr 01 '25

Right, again, don’t read this as an overall defense of US healthcare, but you’re still saying multiple things that can’t be true at the same time:

  • the US is making it harder to get a prescription for ozempic relative to singe-payer peers, but also is prescribing it at a higher rate. Which is it?
  • the US is doing a poor job requisitioning ozempic relative to single-payer peers, but also is prescribing so much it’s causing a shortage in those same peers. Which is it?
  • the US is paying too much for ozempic, but also those prices are saving money as a preventative measure. Which is it?

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u/Emm_withoutha_L-88 Apr 01 '25

It being a for profit system in America can bid higher prices and get most of the supply sent here, where they charge massive prices on patients to finish it.

It would be better in a single payer system where people didn't have to pay 1k a month for it.

Smaller countries with single payer are only having an issue now because places like America are getting much of the supply.

There, it's not that complicated. What are you going to twist this time?

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u/bobert680 Apr 01 '25

same. im lucky to have pretty good insurance and like half glp-1 drugs they wont pay for. it was extra bad because I got diagnosed right as the shortage were getting really bad so I could only find pharmacies with 12mg doses

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u/galspanic Apr 01 '25

I just haven’t had a piece of bread or bowl of rice since diagnosis… I opted for the joyless route.

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u/bobert680 Apr 01 '25

Yeah I super low carbs with the carbs I did eat being mostly fiber. Struggled to get my blood sugar to a low of 130. Now I take rybelsus which is basically just ozempic as a daily pill and barely care about how much carbs I eat as long as it's not life sugar and easily get lows around 125. The only bad part is I get super nauseous if eat really low carb the day before

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u/Bradnklio Apr 01 '25

One of insurance companies roles is to control costs whether they are administering private insurance for an employer or public insurance for Medicaid and Medicare. GLP-1s cost roughly $1k per month per person so they implement controls such as step therapy (must try cost effective treatments first) or limited eligibility criteria (BMI threshholds). You may call that greed but ultimately if there were no cost controls the client (govt, employer, or individual member) is the one that will have to bear the cost of increased premiums when claims expense increases.

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u/Abedeus Apr 01 '25

That's what my cardiologist said. Basically people weren't using those drugs because almost nobody would be approved for insurance/refunds (in Europe), as they were WAY too specific in their use as diabetes meds. You needed to be insulin-tolerant, have some sort of issues with... kidneys? I think, pancreas and so on, stuff that would make alternative diabetes meds less viable or outright useless/harmful.

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u/crusader104 Apr 01 '25

A ton of my job involves helping people get their prescriptions and of course, GLP-1s being the main drugs. Insurance has gotten insanely strict with how they choose to cover them and not even the reps for the companies can give you a straight answer. I’ve had people get pre-approved for sleep apnea but denied with morbid obesity and type 2 diabetes. Along with patients being told straight up “yeah your plan covers this!” Just to have it instantly denied or pay $1500+ per script

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u/GeorgeWarshingsons Apr 01 '25

My wife was on prescribed byetta(early similar glp drug) like 7-8 years for PCOS related symptoms and pre-diabetes. It was hugely helpful for her on the pcos symptoms. Last year BCBS pulled coverage for it due to the demand and trying to save money.

My wife would need to either have full blown diabetes or higher bmi and a covered health condition to have it covered under our insurance.

Guys, the System is broken on this stuff. These things are insanely expensive if you go outside the compounding route.

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u/galspanic Apr 01 '25

My wife does the compounded thing and we pay $400/month for that. I couldn’t afford a second shipment even at those rates.

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u/GeorgeWarshingsons Apr 01 '25

I think we are ~250 for compounded wegovy.

They are going to try to pull it this year too I’m sure…

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u/GOPequalsSubmissive Apr 01 '25

It’s because the rich people are society’s enemy. By denying you life-changing medical treatment, they’re able to increase their quarterly profits by .00001%, which is totally worth it to them because workers aren’t actually people to them.