top of page

Never Have I Ever...


Never have I ever worn button fly jeans. They became popular when I was in high school...but I never wore them because my belly made it pooch out. Well, let me just say that I'm not above hand-me-downs and I gratefully accepted a bunch of clothes from a friend who was getting ready to donate her daughter's clothes. And look what she found! This sweet pair of button-fly Levi's.


I'm at week #34 (7.5 months) into this weight loss journey and have lost 78 total pounds! I'm holding steady at 1-2 pounds per week. I lost 6 pounds in the last 3 weeks and 14 pounds in the last 3 mo.


I jumped up to 15 mg dose last month because the appetite suppression was wearing off after 4 days. It wasn't terrible, because my willpower was still in check, but it sure made it easier when I bumped up to the next dose. This is the end of the road - nothing higher than 15mg. But I'm close to my goal, so I'm good.


I did an InBody Scan to measure weight of bones, fat, muscle and water in my body. Thankfully while the fat has decreased continually, the muscle actually increased 2 pounds in the last month. Losing muscle is definitely a concern on this drug, so I have to be sure to get my 100g of protein every day. I get full easily, so it's good to grab a protein milk, between meals, almonds, or high protein yogurt.



I was half-way through a box of 12.5mg when I didn't feel like the suppression was working. Thanks to my friends on Tik-tok, I found out that I didn't have to wait 21 days to get a refill and use the coupon again. When you bump up or down a dosage, the coupon re-sets even if you are 1 week into a new 4-pack. Whew! Good news!


I know I'm incredibly blessed to have the grandfathered coupon that makes this drug $25/mo. I know it's expensive when insurance doesn't cover it, but I have learned that if you are willing to try and fail other medications in the same drug class, you may be able to get Mounjaro covered. Just a few hoops to jump through.


The "formulary" or list of drugs an insurance provider will cover changes ALL THE TIME. Since Mounjaro is new, it's just now starting to appear on formularies. However, many insurance companies will require a "prior authorization" or "step therapy" before they will cover this medication. Basically they want you to try and make progress on less expensive drugs first.


Things I have learned -

  1. While your doctor may fill out a prior authorization form (PA) to submit to your insurance, it isn't a "billable hour" for them...so they may not put much effort into this and could very well botch it up. How? If they say anything related to "weight loss" on the form, you will be denied. However, if the PA incudes things like, high blood pressure, pre-diabetes, sleep apnea, and insulin resistance....multiple OTHER issues caused by obesity, THEN you have better chances of it getting approved. You see, obesity is a disease that causes other co-morbidities...like fatty liver disease, hypertension, etc. If you treat the obesity, the others will correct themselves...it's just going to take a while for insurance companies to catch up to this change in narrative. So you have to work with the system they have in place...speak their language in the order they prefer.

  2. Sometimes an insurance company will require you to do something called "step therapy" before they will cover Mounjaro...even if you doctor recommends Mounjaro. This basically means they want you to try other drugs in this class of medications first. Other drugs include metformin, Wegovy, Saxenda, Ozempic, Victoza, and Trulicity.

  3. I also learned that trying a sample of these other drugs can count as step therapy as long as your doctor documents it in your chart. A fail can be as simple as stating the drug gave you horrible diarrhea. For example: Metformin is notorious for that particular side effect and is the first drug in the step therapy I'm required to go thru if I want to continue Mounjaro after the coupon expires. Once I fail three other drugs in this class, THEN they would cover Mounjaro.

  4. If insurance covers Mounjaro then a whole new set of rules applies to the coupon on the Eli Lilly website: mounjaro.com. Check it out. Get registered for the coupon. Saving $500 after insurance covers part of it is one step in a positive direction.


So, back to the process.... if my PA submitted by my doc is denied, then I can appeal and write my own PA, and then if that is denied, I can submit to doing step-therapy, and eventually it will be covered. Another coupon from Eli Lilly will probably be coming up the pike too. They can change the terms of their coupons at any time. So there's a little anxiety tied to it...but SOOOOO worth it!


The bottom line here is do not give up. If you run into any roadblocks to starting this journey, DO NOT GIVE UP. If all else fails, try to get into a drug trial. They are currently looking for people who are NOT diabetic and testing Wegovy vs. Mounjaro for the purpose of weight loss. So you will get one drug or the other - a win-win - because there is no placebo in this study. And if they also PAY you for participating along with free drugs, and you get the benefit of a new lease on life, what's not to love?


You can apply to join the drug trials here: https://trials.lilly.com/en-US

If you have any questions, don't hesitate to ask. I share whatever I can to help. You can message me here: marjorie@kauthdesign.com.

28 views0 comments

Recent Posts

See All

No April Fool's Jokes Here - Zepbound Hits Formulary!

The wait is over! Zepbound finally hit my formulary today - THREE months after the FDA approved Tirzepatide (also known as Mounjaro) as a weightloss drug. This means that the drug I've been paying out

Comments


bottom of page