- In the absence of manufacturer coupons, drugs like Ozempic, Mounjaro, and Wegovy can be cost prohibitive, even for people with insurance.
- Because Ozempic and Mounjaro are indicated for diabetes, not weight loss on its own, insurance is unlikely to cover the cost if you don’t have diabetes. Wegovy is indicated for weight loss, but insurance coverage is still not guaranteed.
- There are a number of steps you can take to curb spending on these medications if a healthcare provider determines that you should be taking them.
Social media has been ablaze recently with news of a June 30 expiration of a hugely popular savings coupon for diabetes drug Mounjaro (tirzepatide) provided by manufacturer Eli Lilly.
That’s because the drug’s price is about $1,000 per month or more, regardless of whether you take it for diabetes as it’s indicated for, or for obesity off-label. Ozempic (semaglutide), another diabetes drug routinely prescribed off-label for weight loss, also retails for roughly $1,000 out of pocket. A higher dose of semaglutide, branded as Wegovy, is indicated specifically for weight management, and costs about $1,300 per month.
All three medications, which belong to a class of drugs called GLP-1 agonists, come with coupons that can drop prices as low as $0 instead of north of $12,000 or more a year, depending on your insurance coverage and when you got the coupon. That’s why people losing weight on Mounjaro, some as much as 100 pounds or more, have despaired at the loss of the cost-saving coupon. For now, manufacturer coupons for Ozempic and Wegovy last a year and two years, respectively, from the time a person begins taking the drug.
The coupons are only for people with insurance, with differing amounts of assistance depending on whether the insurer covers the drug or not. The goal of manufacturer coupons is to get insurers’ attention about the new medications.
Eli Lilly has replaced the expiring Mounjaro coupon with one that can bring the cost down to $25 for either a one-month or three-month prescription. But it comes with a new wrinkle—you must check a box that says “I confirm that I have a Mounjaro prescription for Type 2 Diabetes.”
People who have been on the drug for months for obesity and overweight have already seen their prescriptions rejected by pharmacies or insurance if the patient has not been diagnosed with diabetes, according to posters in online patient support groups.
“You have to have T2D (type 2 diabetes), and the pharmacies are hunkering down on that now,” posted a member of a Mounjaro Facebook group this week.
If you’ve been prescribed a drug like Mounjaro, Ozempic, or Wegovy and are finding it hard to keep paying for your medication, here are some options to try.
Don’t Turn to Compounding Pharmacies
People who are losing their financial assistance for Mounjaro and other diabetes or weight loss drugs are turning to Facebook user groups and TikTok for advice from other patients on what to do to. But some of the advice could pose health risks, Jaime Almandoz, MD, an expert in non-surgical weight management at UT Southwestern Medical Center in Houston, told Verywell. For example, he is concerned about patients using versions of semaglutide made by specialty pharmacies called compounding pharmacies, which take raw ingredients and mix the drugs themselves.
In May, the FDA advised consumers against using compounded versions of semaglutide drugs due to issues with both safety and effectiveness.
Almandoz also warned against using less than the prescribed amount of the drugs per month in order to stretch them further.
“The drugs have been studied at specific doses and we don’t know anything about effectiveness and side effects if they are used in other ways,” he said.
Ask Your Doctor to Appeal
If a prescription has been denied by your insurance, your prescribing physician may be able to reach out to ask why and appeal the decision.
Many insurers require “prior authorization” for drugs they don’t currently cover, meaning the doctor submits a letter explaining why you need this drug. Show the doctor any insurance denial letters so that the office doesn’t request the drug for the reason already denied.
Since some pharmacies don’t take coupons, your doctor may know which ones are most likely to accept them.
In rare cases, your doctor could have samples of the drugs, according to online support group members.
Speak With Human Resources
If your insurance comes through your employer, it may be your company that has told the insurance company what they will and won’t cover. Or the plan may not cover it and the human resources department can try to appeal.
“If your employer’s plan doesn’t cover these medicines, you need to talk to your HR department and ask, ‘Are you saying you’ll wait and cover the complications of obesity instead of treating the root problem?'” Ted Kyle, RPh, a pharmacist and head of obesity education and advocacy group Conscienhealth, told Verywell.
Letting an employer know that many people need coverage of a medical expense can sometimes be effective, he said.
Seek Out a Prescription Discount Card
Prescription discount cards, or savings cards, are different from manufacturer coupons. These cards come from for-profit companies such as GoodRx and SingleCare that offer modest reductions off the cost of the drugs. The companies are paid back by middlemen who sell the drugs to the pharmacies.
The pharmacy websites featured on SingleCare list the prices at pharmacies in your area. Keep in mind, though, that there have been shortages of all three drugs recently. If the pharmacy with the lowest price is out, you may have to pay more than the rock bottom cost you found on the site, but likely less than if you simply paid the list price.
Enroll in a Drug Assistance Program
There are foundations across the country that offer help paying for medications when patients cannot afford them, whether that’s because they have no insurance, no insurance coverage for a given medication, or because their insurance copay is unaffordable for them. Obesity is rarely covered, though diabetes can be. Still, a recent search on several sites found only waiting lists for diabetes coverage.
The Medical Assistance Tool, created by the drug industry’s trade association PhRMA, can help you search hundreds of assistance programs to learn where your drug may be partially covered, if at all. Expect drug availability and coverage to change frequently.
Use an FSA or HSA
Two different types of accounts can help you set aside your income for drug costs without paying taxes on it.
Flexible spending accounts (FSAs) are employer-owned accounts that let you put away money to spend on approved health expenses—up to $3,050 this year. The money may be applied to items like copays, medications, contact lenses, and walkers, to name just a few.
If you have an FSA, you can use it for FDA-approved drugs. If they’re not specifically approved for the indication prescribed by your doctor (such as obesity), you may need to show your employer a letter of medical necessity, Charlene Rhinehart, CPA, a personal finance editor with GoodRx, told Verywell.
You can only sign up for FSAs once a year in tandem with health insurance enrollment, unless you’ve had a change in your family like a birth or divorce. Whatever you don’t spend by the end of the year is forfeited. You do not pay taxes on any money placed in an FSA.
Health spending accounts (HSAs), on the other hand, are owned by you and not your employer. HSAs allow people with high deductible plans to set aside up to $3,850 (for individual coverage) to spend on approved health care expenses similar to those of an FSA. For individuals age 55 and older, the maximum is $4,850.
You can open an HSA at any time, and what you don’t spend you can use the next year. If you already have an HSA and use it for a medication (or any other authorized medical expense), you won’t have to pay taxes on the withdrawal. Your human resources office can direct you to bank that can help you set up an HSA account.
Pursue Clinical Trials
Considering a clinical trial might take up your time but not net you an alternative to the drugs you’re trying to afford, Almandoz emphasized. You may have to spend traveling to get to appointments for the trial and end up getting a placebo or a dose that doesn’t work for you.
But clinical trials increasingly may let you take medication at home and report results online. Additionally, trials exist that compare different doses of a drug rather than a drug against a placebo. There are also different types of trials that can include exercise and behavioral health interventions and may be options you can try while waiting to see if insurance begins the cover the drugs. You can find options at ClinicalTrials.gov, but check in with your doctor before starting a clinical trial to be sure it’s right for you.
Consider Other Medications
Mounjaro, Ozempic, and Wegovy are fairly new drugs that are very effective at regulating blood sugar and contributing to weight loss. But if your insurance won’t cover them or you don’t have insurance, there are older drugs that are safe and effective. Any associated weight loss, however, will likely happen slower.
Caroline Apovian, MD, co-director of the Center for Weight Management and Wellness at the Brigham and Women’s Hospital in Boston, said she has a patient who was referred to her because he needs a heart transplant, but won’t qualify until he brings his weight down significantly. That’s because the risk of blood clots and death increases for people who get a heart transplant and are overweight.
“He might have done very well on a semaglutide drug, but his insurance wouldn’t cover it, so we put him on an older [type 2 diabetes] drug, Trulicity (dulaglutide), and he’s losing the weight, though likely much more slowly,” Apovian said.
Almandoz recommends working with your doctor to review available drugs in terms of side effects and cost. Some of the drugs are now generics and available for just a few dollars per prescription. He suggests considering the following medications with your provider:
- Qsymia (phentermine/topiramate): An oral capsule indicated for weight management
- Saxenda (liraglutide): An injection pen indicated for weight management
- Contrave (naltrexone/bupropion): An oral pill indicated for weight management
Write to Your Senator or Representative
Seriously. The Treat and Reduce Obesity Act was first introduced in Congress more than a decade ago and has yet to be introduced this year. What’s more, the lead senator is retiring and it’s not clear who will champion the legislation now. You can find your senators and representatives here.
Medicare does not cover obesity drugs by law (dating back decades to when weight loss drugs were not well-tested and proved to be dangerous for some people), and the new legislation proposes that the agency cover the medications. That’s important even if you’re too young for Medicare, Kyle said, since many insurers begin covering medications and procedures once Medicare does.
Ten states, however, are already covering obesity drugs for Medicaid beneficiaries, according to an analysis from Bloomberg:
- Rhode Island
- New Hampshire
Six states offer limited coverage:
- New Mexico
- South Carolina
- New Jersey
What If You Do Have to Stop Taking These Medications?
If none of the above measures help you afford your medication and you need to stop talking it, the good news is that these GLP-1 agonists drugs can be stopped on a dime without major side effects.
“With Wegovy, Ozempic, and Mounjaro, there aren’t the known effects of discontinuing abruptly as there are with other drug categories such as antidepressants,” Cecilia Low Wang, MD, professor of medicine-endocrinology/metabolism/aiabetes at the University of Colorado School of Medicine, told Verywell. “But there is the likelihood of regaining weight. Studies have shown people can regain as much as two thirds of the weight they lost, and it’s possible to regain even more.”
Will Mounjaro, Ozempic, and Wegovy Ever Be Cheaper?
Later this year, the FDA is expected to approve a version of Mounjaro specifically for weight loss, and the hope is that at least some insurers will cover it. Eli Lilly, however, is making no guarantees about a discount coupon.
“As tirzepatide (Mounjaro’s generic name) is still an investigational therapy for obesity, it is premature to discuss a potential savings program,” Jessica Thompson, an Eli Lilly spokesperson, wrote in an email to Verywell. “As with any potential treatment, our goal is to make our medicines widely available and accessible to as many people as possible.”