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From Coverage to Crisis: The Changing Landscape of GLP-1 Drugs

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Күн бұрын

Пікірлер: 49
@lisatipton5547
@lisatipton5547 2 ай бұрын
So frustrating. I live in Michigan so this hits home with me, even though my BCBS is with IL because of my employer. The CEO of BCBS made a base salary of $1.7M in 2023 with a BONUS of $12.3M!!!! His insurance and benefits total $1.6M! I bet he can get his GLP-1! Company cleared $100M profit. They are not the victims here. Like you said, it’s the patient as always.
@thedownsized
@thedownsized 2 ай бұрын
Omg!😱 unbelievable
@dianeodgers4700
@dianeodgers4700 2 ай бұрын
Thank goodness for Compounds! ❤
@thedownsized
@thedownsized 2 ай бұрын
I’ve only done compounded Tirzepatide. get $40 off using code QIYGO8 Joinmochi.com
@joannamaria1353
@joannamaria1353 2 ай бұрын
It is almost an impossibility to get these medications on the NHS in the UK so buying off label is most people's only option. Mounjaro only cost £130 a month here though, which is a blessing.
@jetzon3699
@jetzon3699 2 ай бұрын
in 3 months , A1C from 6.1 to 5.4 / -36# / Mounjaro,,,the best thing ever!
@thedownsized
@thedownsized 2 ай бұрын
Great job!👏
@MindyMikami
@MindyMikami 2 ай бұрын
Great content. I really feel for those who are losing coverage due to insurance companies’ greed. I think it’s especially shady to change the “rules” mid-term.
@thedownsized
@thedownsized 2 ай бұрын
Very shady! They figured out it was expensive for them to cover :(
@user-dn8ij7tu7y
@user-dn8ij7tu7y 2 ай бұрын
Great content!! I really like the news segment.
@thedownsized
@thedownsized 2 ай бұрын
Thanks! Christopher loves the news 📰
@mariacampbell581
@mariacampbell581 2 ай бұрын
this is why I investigated and started with a compound pharmacy It's still pricey but not $1200 a month
@thedownsized
@thedownsized 2 ай бұрын
Yep thats why we use Mochi
@jc10907Sealy
@jc10907Sealy 2 ай бұрын
My Insurance will pay for Zepbound but I’ve had a past episode of gallstone pancreatitis so they denied me. My doctor said proceed with caution (now that my gallbladder is gone after surgery). I use the Eli Lilly coupon so I pay $550 a month out-of-pocket.
@thedownsized
@thedownsized 2 ай бұрын
Always best to follow your doctor’s advice ❤️
@cinnamon551
@cinnamon551 2 ай бұрын
I used to process PA for a BC/ BS . PA is based on the cost of medication and which medications the company gets a rebate . Certain medications require a certain diagnosis code. Once you pass that hurdle they look BMI, medications tried and failed
@thedownsized
@thedownsized 2 ай бұрын
Walgreens wanted a diagnosis code from the Dr. No other pharmacies have asked for that.
@valeriemartini6315
@valeriemartini6315 2 ай бұрын
Good information ℹ️
@thedownsized
@thedownsized 2 ай бұрын
Thanks
@annettelundy7426
@annettelundy7426 2 ай бұрын
Im 18 years into my gastric bypass. I lost 120 pounds in 14 months. Two years later ALL the weight came back. The nutrients that are not absorbed include B vitamins. Living my life deficiant in these is NO picnic. A pill that replicates this is not a step forward. IMO. Thank you for this video. Lots of interesting info.
@thedownsized
@thedownsized 2 ай бұрын
Are you on a GLP-1 now? I see several people try them after weight loss surgery. Unfortunately weight loss surgery doesn't stop the hunger or the food noise. Thanks for your comment!
@annettelundy7426
@annettelundy7426 2 ай бұрын
@@thedownsized Yes Im 12 weeks into Zepbound. Ive lost 22 pounds so far. Ive got 120 more to go. I believe that this med can get me there...and maintain the loss.
@thedownsized
@thedownsized 2 ай бұрын
Congratulations on your weight loss! Keep us posted on your progress! 😍
@elizabethvarnadoe420
@elizabethvarnadoe420 2 ай бұрын
I have to jump through hoops and I am type 2 diabetic. I have to talk to a Diabetic nurse each month to get my mounjaro. I have BCBS of Georgia. So far they are paying for my medicine. Mounjaro has lowered my A1C from 11 to 6.2. I’m retired from our state school system but will be turning 65 next year in 2025.
@thedownsized
@thedownsized 2 ай бұрын
Sounds painful, but you do what you have to do! I'm glad you are able to get it covered.
@felicerobinson
@felicerobinson 2 ай бұрын
Keep in mind compounding is allowed due to shortages. If reduced coverages result in fewer shortages, one wonders whether compounds will continue to be available?
@thedownsized
@thedownsized 2 ай бұрын
This is christopher - that is the there but the reality is more than 40% of America is obese and even the Eli Lilly Ceo does not believe they will catch up with demand until they have a daily pill that can be easily manufactured> Compounding can also be legally used in its traditional form as a way to create custom versions of these drugs combining them with other meds (b12 is common) is the process of combining, mixing, or altering ingredients to create a medication tailored to the needs of an individual patient
@Demetra825
@Demetra825 2 ай бұрын
The North Carolina State Health Plan stopped approving GLP-1 drugs for weight loss in April 2024. Prior to that I could not get the drugs due to shortage. To complete my weight loss journey I’m going to a NP and paying out of pocket for compound shots not regulated by FDA. Hope they work.
@thedownsized
@thedownsized 2 ай бұрын
Compounders are regulated by the State, We have used Mochi for telehealth and they have used Hallendale pharmacy out of Florida for our medications. Laraine has used them her entire time. You've got this!
@cinnamon551
@cinnamon551 2 ай бұрын
It also depends if it is fully funded versed self funded. Is your insurance plan fully funded or self funded ?
@thedownsized
@thedownsized 2 ай бұрын
We have coverage through the Marketplace. Previously I have worked for a big company that was self funded. They didn't like to cover ANYTHING
@sallysmack9372
@sallysmack9372 2 ай бұрын
A for-profit healthcare system is insane, and the only way we are going to change this is to become informed voters.
@thedownsized
@thedownsized 2 ай бұрын
Yes and yes! Everyone get out there and VOTE 🗳️
@cinnamon551
@cinnamon551 2 ай бұрын
I would suggest for anyone who is getting there glp 1 covered to log your food . Invest in a wearable excersise tracking device . If one blue cross is rolling this out the others will follow , be prey
@thedownsized
@thedownsized 2 ай бұрын
Not a bad idea, definitely keep a log of your weight if nothing else. Your iphone tracks your steps. Also if you are covered make sure to fill it every 28 days!
@ampharris9710
@ampharris9710 2 ай бұрын
Got a letter today and I’m in Florida but it just said excluded
@thedownsized
@thedownsized 2 ай бұрын
Oh no. I’m sorry.
@ampharris9710
@ampharris9710 2 ай бұрын
@@thedownsizedit’s ok I started out with the compound and it works but it’s still about a 200 difference in money
@fantasticallyfit6030
@fantasticallyfit6030 2 ай бұрын
I’m not a big insurance person. But this is a Peptide drug. Way overpriced. It is not that expensive to make. Big pharma needs to reduce the price.
@thedownsized
@thedownsized 2 ай бұрын
Agreed!
@lindabookmiller8803
@lindabookmiller8803 2 ай бұрын
I’m still confused about how the compound pharmacies actually get the drugs. I know they CAN add vitamins to it to make it “compounded”, but mine is just straight tirzepatide just like the drug in the injector pens from EL….so how does EL allow this cash cow of this drug that is still under patent, to be duplicated in random pharmacies around the country? Are they giving them the “recipe” to make it? Are they shipping the liquid to the pharmacies in large quantities for it to be bottled in vials and then managed to customers? Do the compound pharmacies then have to pay EL a reduced price for them kind of like a wholesaler or middle man. I always envisioned a compound pharmacist as someone with a mortar and pestle mixing up concoctions per Dr orders on individual basis…but these can’t work that way since they are patented. How long will EL allow this to go on…unless they are still making a ton by selling it to the compound pharmacies? Insurance companies are forcing people into compounds. Drug companies have to be OK with it or they would put a stop to it. Sorry so long!
@thedownsized
@thedownsized 2 ай бұрын
According to the FDA Sections 503A and 503B of the Food, Drug, and Cosmetic Act set conditions under which compounded human drug products are exempt from certain federal requirements, such as pre-market drug approval. pi.lilly.com/us/zepbound-us-mg.pdf Lilly holds a patent Zepbound and mounjaro: chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/patentimages.storage.googleapis.com/6e/ea/64/6dc49bc3fc7df9/US11357820.pdf It does not however mean that it is impossible to manufacture as the peptides and base ingredients are easily obtainable,. So no Lilly is not selling this to the compounders and they are not making money off of it. They have talked about it and they are not happy, but given FDA regs below they have very little choice. In the long run compounding makes the market much larger for what they are selling so it will grow their business. but yes they would love to capture every dollar. FDA's statements Section 503A addresses compounding by state-licensed pharmacies, among others, who make and distribute drugs based on individual patient prescriptions. Such pharmacies make up a majority of compounders in the U.S. and are primarily regulated by the states. If these compounded drugs meet the conditions of section 503A they are also exempt from current good manufacturing practice requirements - the quality standard generally applied to drug manufacturers. One of the conditions of section 503A restricts compounded drugs that are essentially copies of commercially available drugs, but FDA does not consider a drug to be commercially available when it appears on FDA’s drug shortages list. If a drug is not in shortage, “copies” can be compounded under section 503A as long as the compounding is not done "regularly or in inordinate amounts." All other conditions of section 503A would have to be met, including compounding based on a valid prescription for an identified individual patient. Section 503B addresses compounding by “outsourcing facilities” - a special group of compounders that may distribute supplies of drugs directly to doctor’s offices or hospitals without receiving individual patient prescriptions. Outsourcing facilities register with FDA, must comply with current good manufacturing practice requirements, and report products they produce to FDA, among other requirements. www.fda.gov/drugs/human-drug-compounding/drug-compounding-and-drug-shortages#:~:text=If%20a%20drug%20is%20not,for%20an%20identified%20individual%20patient.
@thedownsized
@thedownsized 2 ай бұрын
@Lindabookmiller8803 Tirzepatide is a peptide, or hormone. Eli Lilly didn't "create" this in a lab. It is a naturally occurring hormone in humans. Eli Lilly has nothing do to with the compounded versions.
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