Semaglutide is the microcosm for the failed American insurance system

Two Sandwiches · Mar 20, 2024

I'll try to keep this brief. In doing so, I'll leave out some thoughts, I'm sure. Title says it all though.

I am 6'2"-6'3", and over the last 2 to 3 years, due to bad habits and a new job (100 miles one way to work... sometimes more), I have gained a substantial amount of weight. I'm currently at my heaviest ever, sitting somewhere between 265-270. While I carry it fairly well, I don't like being fat and I judge myself constantly for it. I'm far more comfortable around 215, when a large shirt will hang off me. So I went to the doctor to have the "Ozempic talk."

Essentially what it boils down to is a lack of production and a huge price tag. Any semaglutide product is essentially not covered under insurance, despite the fact that obesity is the biggest pandemic our country has ever faced. It is the leading cause of death, and inflates patient numbers in an already stuffed-to-the-gills and worn out national healthcare crisis. Not only that, but it has been shown in more recent studies to promote better cardiovascular health, and to decrease potentially fatal or life changing cardiovascular complications - another huge factor in me seeking this out (heart/stroke issues on both sides of the family).

So I go to the doctor, and he tells me he's more than willing to prescribe these meds, and would love to. Problem is, Ozempic and Wegovy are backordered (as most know). He (and I) recommend Mounjaro, but he says it's around $1500 a month. I called and was told $1000, to be up front.

Here's the crazy thing: I've seen articles stating prices are $35-50 a month in countries like France and Japan. Let that sink in. The difference in the average person being able to afford these meds in different countries is huge. This is due mostly to these countries being able to negotiate directly with pharmaceutical companies and lower prices - something Biden and our government recently enacted. Problem is, here it's a slow rollout and only certain meds are covered.

I believe that semaglutide for weight loss is one of the most significant medical developments in the last 20 years, and I don't say that lightly. I also believe that our for-profit insurance companies only see dollar signs from people getting sick. There's no money in preventative care. Some of this blame is on the hospitals, as well, but not nearly as much. I think this is the biggest contributor to the declining world ranks on lifespan and healthcare, in general, that our country has.

Here's the other kicker: I work for a hospital system that is owned by an insurance company. I pay for the best insurance offered. I pay about $350 a paycheck for my family's health insurance, and while it's pretty decent, it doesn't cover something like this.

So, instead, I got put on a medicine akin to legal speed/cocaine and told to go on the slim fast diet. This med (phentermine) has been shown to have a potential side effect of heart attacks, suicidal ideations, and kidney failure.

Something's got to change.

Jugdish · Mar 20, 2024

Maybe cut down to one sandwich instead of seeking pharmaceutical answers.

No Worries · Mar 20, 2024

maybe a run to Mexico? they sell the damnest things straight off the shelf down there.

Amiga · Mar 20, 2024

for profit health capitalist system doesn't work when demand is infinite

Xopher · Mar 20, 2024

What sucks is it was originally designed for diabetics. I am one and was prescribed this a long time ago. However, since people want to use it for weight loss it is harder than hell for me to get it for the actual medical issue I have, that it was designed for.

cwebbster · Mar 20, 2024

Two Sandwiches said: ↑

I'll try to keep this brief. In doing so, I'll leave out some thoughts, I'm sure. Title says it all though.

I am 6'2"-6'3", and over the last 2 to 3 years, due to bad habits and a new job (100 miles one way to work... sometimes more), I have gained a substantial amount of weight. I'm currently at my heaviest ever, sitting somewhere between 265-270. While I carry it fairly well, I don't like being fat and I judge myself constantly for it. I'm far more comfortable around 215, when a large shirt will hang off me. So I went to the doctor to have the "Ozempic talk."

Essentially what it boils down to is a lack of production and a huge price tag. Any semaglutide product is essentially not covered under insurance, despite the fact that obesity is the biggest pandemic our country has ever faced. It is the leading cause of death, and inflates patient numbers in an already stuffed-to-the-gills and worn out national healthcare crisis. Not only that, but it has been shown in more recent studies to promote better cardiovascular health, and to decrease potentially fatal or life changing cardiovascular complications - another huge factor in me seeking this out (heart/stroke issues on both sides of the family).

So I go to the doctor, and he tells me he's more than willing to prescribe these meds, and would love to. Problem is, Ozempic and Wegovy are backordered (as most know). He (and I) recommend Mounjaro, but he says it's around $1500 a month. I called and was told $1000, to be up front.

Here's the crazy thing: I've seen articles stating prices are $35-50 a month in countries like France and Japan. Let that sink in. The difference in the average person being able to afford these meds in different countries is huge. This is due mostly to these countries being able to negotiate directly with pharmaceutical companies and lower prices - something Biden and our government recently enacted. Problem is, here it's a slow rollout and only certain meds are covered.

I believe that semaglutide for weight loss is one of the most significant medical developments in the last 20 years, and I don't say that lightly. I also believe that our for-profit insurance companies only see dollar signs from people getting sick. There's no money in preventative care. Some of this blame is on the hospitals, as well, but not nearly as much. I think this is the biggest contributor to the declining world ranks on lifespan and healthcare, in general, that our country has.

Here's the other kicker: I work for a hospital system that is owned by an insurance company. I pay for the best insurance offered. I pay about $350 a paycheck for my family's health insurance, and while it's pretty decent, it doesn't cover something like this.

So, instead, I got put on a medicine akin to legal speed/cocaine and told to go on the slim fast diet. This med (phentermine) has been shown to have a potential side effect of heart attacks, suicidal ideations, and kidney failure.

Something's got to change.
Click to expand...

Bro I just started Mounjaro last month, and it is covered 100% by my insurance. I have a shitty high deductible plan, but an awesome prescription plan. I have like 90 days worth right now I did not pay a penny for. Caveat though, is I went from a person who was never a diabetic, to a diabetic. Having that as the reason for the prescription, helped justify the 100% coverage.

Did your doctor diagnose you as such?

xtruroyaltyx · Mar 20, 2024

There are coupons you can find online to get it cheaper.

snowconeman22 · Mar 20, 2024

Jugdish said: ↑

Maybe cut down to one sandwich instead of seeking pharmaceutical answers.
Click to expand...

all joking aside , definitely this

change the diet first.

otherwise you will need a different pill in 5 years for another side effect of poor eating habits

also try to move your body . the drive is killer . but get up 30 minutes earlier and make a stop and take a walk.

painful habit change , yes.

worth it over medicine, yes.

agree with you that the system is broken and preventative care should be prioritized

DFWRocket · Mar 20, 2024

It's not just the crappy for-profit healthcare, but it's our entire culture. Our work culture says that if you work a measly 40 hours a week you really aren't working, so we work so much we don't have time to get proper exercise. Our school and social culture encourages so many extracurricular activities that we spend a ton of time farrying our children around. With less time, we eat more processed foods because we're not cooking as much. Then by the time we get home, we're too tired to walk the treadmill that's sitting in the house.

KingCheetah · Mar 20, 2024

Mix a semi glue like Elmer's and a tide pod -- problem solved.

Invisible Fan · Mar 20, 2024

DFWRocket said: ↑

It's not just the crappy for-profit healthcare, but it's our entire culture. Our work culture says that if you work a measly 40 hours a week you really aren't working, so we work so much we don't have time to get proper exercise. Our school and social culture encourages so many extracurricular activities that we spend a ton of time farrying our children around. With less time, we eat more processed foods because we're not cooking as much. Then by the time we get home, we're too tired to walk the treadmill that's sitting in the house.
Click to expand...

Our entire food system is pretty ****ed up. Sugar in everything, fake sugar in everything else.

Eating less with processed food and diet substitutes won't matter nutritionally and will make you hunger for more.

Nutritious and fulfilling foods are more expensive and time consuming.

It might not even taste that great compared to the processed stuff.

Xopher · Mar 20, 2024

cwebbster said: ↑

Bro I just started Mounjaro last month, and it is covered 100% by my insurance. I have a shitty high deductible plan, but an awesome prescription plan. I have like 90 days worth right now I did not pay a penny for. Caveat though, is I went from a person who was never a diabetic, to a diabetic. Having that as the reason for the prescription, helped justify the 100% coverage.

Did your doctor diagnose you as such?
Click to expand...

You're right. It is covered under your prescription plan if you are diabetic or pre-diabetic. It is people using it for off-label purposes who have to pay. What sucks is I am on Ozempic. My insurance won't pay to refill it until a few days before my prescription is up. So since there is a shortage due to off-label usage I am usually out of it for a week before the pharmacy has stock.

Rocket River · Mar 20, 2024

DFWRocket said: ↑

It's not just the crappy for-profit healthcare, but it's our entire culture. Our work culture says that if you work a measly 40 hours a week you really aren't working, so we work so much we don't have time to get proper exercise. Our school and social culture encourages so many extracurricular activities that we spend a ton of time farrying our children around. With less time, we eat more processed foods because we're not cooking as much. Then by the time we get home, we're too tired to walk the treadmill that's sitting in the house.
Click to expand...

Definitely True

Rocket River

leroy · Mar 20, 2024

Two Sandwiches said: ↑

I'll try to keep this brief. In doing so, I'll leave out some thoughts, I'm sure. Title says it all though.

I am 6'2"-6'3", and over the last 2 to 3 years, due to bad habits and a new job (100 miles one way to work... sometimes more), I have gained a substantial amount of weight. I'm currently at my heaviest ever, sitting somewhere between 265-270. While I carry it fairly well, I don't like being fat and I judge myself constantly for it. I'm far more comfortable around 215, when a large shirt will hang off me. So I went to the doctor to have the "Ozempic talk."

Essentially what it boils down to is a lack of production and a huge price tag. Any semaglutide product is essentially not covered under insurance, despite the fact that obesity is the biggest pandemic our country has ever faced. It is the leading cause of death, and inflates patient numbers in an already stuffed-to-the-gills and worn out national healthcare crisis. Not only that, but it has been shown in more recent studies to promote better cardiovascular health, and to decrease potentially fatal or life changing cardiovascular complications - another huge factor in me seeking this out (heart/stroke issues on both sides of the family).

So I go to the doctor, and he tells me he's more than willing to prescribe these meds, and would love to. Problem is, Ozempic and Wegovy are backordered (as most know). He (and I) recommend Mounjaro, but he says it's around $1500 a month. I called and was told $1000, to be up front.

Here's the crazy thing: I've seen articles stating prices are $35-50 a month in countries like France and Japan. Let that sink in. The difference in the average person being able to afford these meds in different countries is huge. This is due mostly to these countries being able to negotiate directly with pharmaceutical companies and lower prices - something Biden and our government recently enacted. Problem is, here it's a slow rollout and only certain meds are covered.

I believe that semaglutide for weight loss is one of the most significant medical developments in the last 20 years, and I don't say that lightly. I also believe that our for-profit insurance companies only see dollar signs from people getting sick. There's no money in preventative care. Some of this blame is on the hospitals, as well, but not nearly as much. I think this is the biggest contributor to the declining world ranks on lifespan and healthcare, in general, that our country has.

Here's the other kicker: I work for a hospital system that is owned by an insurance company. I pay for the best insurance offered. I pay about $350 a paycheck for my family's health insurance, and while it's pretty decent, it doesn't cover something like this.

So, instead, I got put on a medicine akin to legal speed/cocaine and told to go on the slim fast diet. This med (phentermine) has been shown to have a potential side effect of heart attacks, suicidal ideations, and kidney failure.

Something's got to change.
Click to expand...

First, ignore all of these schmucks who think that everyone is the same and just changing habits will be the cure to all. Not all of us are built the same. About a year ago, I had gotten to my heaviest...about 256 (I'm 5'10"). I play soccer regularly and work out 4-5 times per week. My eating habits aren't great...but they weren't the worst either. I'm genetically predisposed to being big and just don't have the metabolism to lose weight. I needed help. I went to my dr and had the same conversation. My insurance also doesn't cover Wegovy and since I'm not diabetic, no chance at Ozempic either. He sent me to a compunding pharmacy in The Woodlands. I get semaglutide from them. It's $300 for 2 2ml vials which last me about 6 weeks. I give myself an injection every Friday.

In this last year, I've gone from 256 to 216. I've leveled off lately and also am taking smaller doses. I'm less careful about what I eat but more careful about how much. I don't get the same dramatic effects from taking it I used to so I am just being more conscious about my intake. The weight stays off so far and I'm thinking about weeing off completely. I was hoping to get to 210 but I'm satisfied with where I am.

tinman · Mar 20, 2024

Two Sandwiches said: ↑

I'll try to keep this brief. In doing so, I'll leave out some thoughts, I'm sure. Title says it all though.

I am 6'2"-6'3", and over the last 2 to 3 years, due to bad habits and a new job (100 miles one way to work... sometimes more), I have gained a substantial amount of weight. I'm currently at my heaviest ever, sitting somewhere between 265-270. While I carry it fairly well, I don't like being fat and I judge myself constantly for it. I'm far more comfortable around 215, when a large shirt will hang off me. So I went to the doctor to have the "Ozempic talk."

Essentially what it boils down to is a lack of production and a huge price tag. Any semaglutide product is essentially not covered under insurance, despite the fact that obesity is the biggest pandemic our country has ever faced. It is the leading cause of death, and inflates patient numbers in an already stuffed-to-the-gills and worn out national healthcare crisis. Not only that, but it has been shown in more recent studies to promote better cardiovascular health, and to decrease potentially fatal or life changing cardiovascular complications - another huge factor in me seeking this out (heart/stroke issues on both sides of the family).

So I go to the doctor, and he tells me he's more than willing to prescribe these meds, and would love to. Problem is, Ozempic and Wegovy are backordered (as most know). He (and I) recommend Mounjaro, but he says it's around $1500 a month. I called and was told $1000, to be up front.

Here's the crazy thing: I've seen articles stating prices are $35-50 a month in countries like France and Japan. Let that sink in. The difference in the average person being able to afford these meds in different countries is huge. This is due mostly to these countries being able to negotiate directly with pharmaceutical companies and lower prices - something Biden and our government recently enacted. Problem is, here it's a slow rollout and only certain meds are covered.

I believe that semaglutide for weight loss is one of the most significant medical developments in the last 20 years, and I don't say that lightly. I also believe that our for-profit insurance companies only see dollar signs from people getting sick. There's no money in preventative care. Some of this blame is on the hospitals, as well, but not nearly as much. I think this is the biggest contributor to the declining world ranks on lifespan and healthcare, in general, that our country has.

Here's the other kicker: I work for a hospital system that is owned by an insurance company. I pay for the best insurance offered. I pay about $350 a paycheck for my family's health insurance, and while it's pretty decent, it doesn't cover something like this.

So, instead, I got put on a medicine akin to legal speed/cocaine and told to go on the slim fast diet. This med (phentermine) has been shown to have a potential side effect of heart attacks, suicidal ideations, and kidney failure.

Something's got to change.
Click to expand...

@Jontro
@Rocket River
@Os Trigonum
@basso

you got to dance it off breh
Trust Mike

tinman · Mar 20, 2024

@Jontro
@Two Sandwiches
@basso
you could hit the treadmill or you can be like Mike

Nook · Mar 20, 2024

Xopher said: ↑

What sucks is it was originally designed for diabetics. I am one and was prescribed this a long time ago. However, since people want to use it for weight loss it is harder than hell for me to get it for the actual medical issue I have, that it was designed for.
Click to expand...

This - and it is now being resourced for weight loss, which isn't right - at least not until every diabetic has access. I had an RX for Wegovy and was going to fill it until my friend, who is a doctor explained to me that the same chemicals and ingredients are being diverted from those that are diabetic so I can lose weight... so I did not fill it and won't until the shortage is gone.

Nook · Mar 20, 2024

KingCheetah said: ↑

Mix a semi glue like Elmer's and a tide pod -- problem solved.
Click to expand...

tinman · Mar 20, 2024

Two Sandwiches said: ↑

I'll try to keep this brief. In doing so, I'll leave out some thoughts, I'm sure. Title says it all though.

I am 6'2"-6'3", and over the last 2 to 3 years, due to bad habits and a new job (100 miles one way to work... sometimes more), I have gained a substantial amount of weight. I'm currently at my heaviest ever, sitting somewhere between 265-270. While I carry it fairly well, I don't like being fat and I judge myself constantly for it. I'm far more comfortable around 215, when a large shirt will hang off me. So I went to the doctor to have the "Ozempic talk."

Essentially what it boils down to is a lack of production and a huge price tag. Any semaglutide product is essentially not covered under insurance, despite the fact that obesity is the biggest pandemic our country has ever faced. It is the leading cause of death, and inflates patient numbers in an already stuffed-to-the-gills and worn out national healthcare crisis. Not only that, but it has been shown in more recent studies to promote better cardiovascular health, and to decrease potentially fatal or life changing cardiovascular complications - another huge factor in me seeking this out (heart/stroke issues on both sides of the family).

So I go to the doctor, and he tells me he's more than willing to prescribe these meds, and would love to. Problem is, Ozempic and Wegovy are backordered (as most know). He (and I) recommend Mounjaro, but he says it's around $1500 a month. I called and was told $1000, to be up front.

Here's the crazy thing: I've seen articles stating prices are $35-50 a month in countries like France and Japan. Let that sink in. The difference in the average person being able to afford these meds in different countries is huge. This is due mostly to these countries being able to negotiate directly with pharmaceutical companies and lower prices - something Biden and our government recently enacted. Problem is, here it's a slow rollout and only certain meds are covered.

I believe that semaglutide for weight loss is one of the most significant medical developments in the last 20 years, and I don't say that lightly. I also believe that our for-profit insurance companies only see dollar signs from people getting sick. There's no money in preventative care. Some of this blame is on the hospitals, as well, but not nearly as much. I think this is the biggest contributor to the declining world ranks on lifespan and healthcare, in general, that our country has.

Here's the other kicker: I work for a hospital system that is owned by an insurance company. I pay for the best insurance offered. I pay about $350 a paycheck for my family's health insurance, and while it's pretty decent, it doesn't cover something like this.

So, instead, I got put on a medicine akin to legal speed/cocaine and told to go on the slim fast diet. This med (phentermine) has been shown to have a potential side effect of heart attacks, suicidal ideations, and kidney failure.

Something's got to change.
Click to expand...

@Jontro
@Os Trigonum
@Space Ghost
@pgabriel
find someone who will workout with you
Example

Two Sandwiches · Mar 20, 2024

cwebbster said: ↑

Bro I just started Mounjaro last month, and it is covered 100% by my insurance. I have a shitty high deductible plan, but an awesome prescription plan. I have like 90 days worth right now I did not pay a penny for. Caveat though, is I went from a person who was never a diabetic, to a diabetic. Having that as the reason for the prescription, helped justify the 100% coverage.

Did your doctor diagnose you as such?
Click to expand...

No, this is my issue. Not diabetic, no sleep apnea, nothing that he can diagnose me with to support it. Lol

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Semaglutide is the microcosm for the failed American insurance system

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Semaglutide is the microcosm for the failed American insurance system

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