I know some GPs are also suggesting that if someone is at a weight they need to be at, continuing a low dose helps keep that weight gain from happening. I think it's like 15% weight is gained back if you stop ozempic/wegovy, even if you continue your current lifestyle mods. (this is off the top of my head so don't quote me. I know there are studies, look at those instead of a random lady on reddit!)
Thank you. My god, this is what separates us from robots/AI that can't do anything but regurgitate the guidelines and package inserts. If a drug is showing results and the patient is tolerating it, why would you increase to something they may not be able to tolerate?
And it might even be better if the lower dose is also causing them to lose weight if its happening slower. Give their body more time to adjust and reabsorb the excess skin and avoid "ozempic face" and other areas where loose skin can accumulate.
I don’t understand why doctors have so much power to prescribe anything and get away with it while we get written up for incorrect refills amount of some shit
The 0.25-mg dose can be effective at appetite suppression (weight loss) for much longer than the four weeks the official presribing label indicates. A lot of people will stay at 0.25 mg/week for as long as it remains effective -- many months -- and only increase when that dose is no longer sufficient to control appetite.
While this doesn't adhere to the official prescribing info, there's really no need to increase the dose if the current dose is working. Especially since increasing the dose also tends to increase adverse effects like nausea and constipation.
Interesting to know, I haven’t really had the opportunity to discuss how it’s been working for them at that dose. Saw one with a stop in adjudication to get verification from provider on continuation of 0.25mg dose about an hour before close today but didn’t have any previous notes on file. It was slow and I was curious, and I ended up finding a few more in my contact queue that still needed followed up on. I wasn’t able to find any studies showing efficacy of that dose for weight loss or glycemic control, so I made this post to see if my initial thoughts were misguided.
https://diabetesjournals.org/care/article/39/2/231/37200/A-Phase-2-Randomized-Dose-Finding-Study-of-the
This shows 0.2 mg is more effective than placebo in terms of glycemic control.
On top of that, we know Ozempic is effective for both diabetes and obesity. Just because the company didn’t pursue a dosing strategy incorporating 0.25 doesn’t mean that dose can’t be effective. It shouldn’t be a big surprise that some Ozempic can be better than no Ozempic,
This is interesting because it actually kind of goes along with a comment I was just writing up. If the manufacturer says the discontinue the medication if a patient fails initial dose titration, why is the answer to stay on that medication? Just a Quick Look at what you linked the 1.2mg Victoza lowered A1c further than 0.4mg Ozempic. Maybe the patient being kept on 0.25 Ozempic can tolerate 1.2mg Victoza, but we can’t know because these doctors aren’t trying.
Who is saying the patient failed the titration? I am not exactly following your point but I would only continue Ozempic 0.25 mg if the patient was meeting their glycemic and weight goals and that happens fairly often especially in newly diagnosed diabetics. Otherwise I would change GLPs. I would probably not try Victoza unless insurance required it due to it being daily and poorly tolerated especially compared to the weekly formulations.
Sorry, I guess it wasn’t very clear in my initial post. What I’m talking about is these doctors that are okaying these 0.25mg continuations without even attempting a different GLP-1, especially if they already weren’t controlled on oral meds. Maybe it’s the doctors offices around me, tele docs not giving a shit, or I got lucky and only looked at the bad examples at work today. Maybe I’m thinking like I’m still in school too much. Who knows.
I wouldn’t suggest Victoza either, im surprised I still have patients on it considering the alternatives. That’s just what the linked study used as a comparator to semaglutide.
Well if you know they are not controlled on the regimen, that would be annoying and negligent knowing they are on only Ozempic 0.25. But if they are controlled I can understand the lack of inertia to titrate Ozempic and discontinue other meds/optimize the regimen.
Yep, plus; if someone isn’t building actively healthy habits with the appetite suppression, it’s an early indicator that these drugs won’t work in the long run. They’ll benefit for the time being so if they can pay or want to pay then sure. But no reason to put them through a potentially life disrupting GI ADRs from increasing to a harder to tolerate dose without initiating that CBT necessary to maintain long lasting healthy lifestyle habits
This is my thing. The manufacturer recommend that 0.25b isn't a therapeutic dose. I'm just not understanding where people are saying "use clinical thought process". You going to keep a patient on a dose that may or may not be therapeutic for weight loss and if it's not they are stuck with 2 or 1 dose.
But actually as I was typing I guess if they go up to 0.5, they'll technically have 2 extra pen needles in the next box? Just use those and no wasted doses. If there staying on 0.25 then just prescribe extra needles?
Idk it just feels weird using such a low dose and going against a manufacturer recommendation. Personally I've never seen any one we have put on either victoza or ozempic have any success on the lowest "titration" dose. And we were churning out ozempic scripts when the boom started and it was still 340b pricing, but that's also personal and anecdotal so.
The issue is that specifically victoza has less weight loss effect overall, and it’s very easy for people to take ozempic or wegovy and have really bad GI ADRS that could take a couple weeks for the body to get used to.
On top of that; I’ve seen some physicians like to schedule a nutritionist meeting with the patient to develop a weight loss regimen, and develop healthier eating habits before going up to the therapeutic doses so that the weight loss can stick.
Obviously this is also anecdotal; but just a thought as to why some physicians may be keeping patients having a harder time at a sub therapeutic dose if they’re transitioning/waiting on other appointments, that way they’ll have the largest affect once they get that therapeutic dose but will also be able to more readily tolerate the higher dosage without wanting to quit because they may or may not shit their intestines out metaphorically lmao
My only issue is with the ozempic and the day supply. Most insurances won’t pay for the 56 days supply at 0.25mg weekly with the 3ml pen, and I’m sure an audit by most insurances would result in a loss if it’s billed for 30 days.
Anyone who haa gone through audits on either side able to shed light? If ins limits to 30ds (which also means the intended 42 ~~week~~ day supply is not "approved"), but we're only dispensing a 3ml pen every 8 weeks, does that actually have merit on clawbacks? I can understand, certainly, if we kept filling 0.25mg/week directions and dispensed 12 boxes in a year that pbms have a cause there for taking back on audit. But if only 6 boxes in a year, dispensinf every other month, I don't see how the insurance was paying for too much.
I did the chargebacks for a large chain pharmacy for 22 years. If you annotate on Rx when typing cannot break open box so must bill for 28 days … insurance covers it no chargeback . Since we don’t break open Ozempic , it’s similar to other package like eye drops , maybe it’s a 80 day supple as written but they are only using for 14 days and insurance doesn’t cover over 30, wee annotate for 14 days and bill for actual use … see it a lot on eye drops for eye procedures
It’s wild that insurance wants the patient to use more Ozempic. I would think they would be happy to pay for less. And yes, patients absolutely can have benefit at a dose of 0.25 mg.
Insurance companies must adhere to the prescribing information based on clinical trial data, as these guidelines dictate the required dosage increases. While prescribers can opt for off-label use (stay on same dose) , insurance companies potentially will cut coverage if guidelines are not followed. This restriction does not apply if you’re paying out of pocket.
It’s because weight loss saves them money in the long run. It’s a catch 22. They don’t care as long as the patient is using it because they’ve calculated that with the weight loss predicted they could potentially save millions yearly if every single person over bmi with an insurance plan with them were on it
That’s an interesting take as Ozempic is usually denied in favor of Wegovy if I’m prescribing for obesity and many insurance plans, including Medi-Care do not pay for weight loss medications.
It’s not an interesting take it’s the reason that any insurance company would actually pay for such a medication. They don’t pay out of the goodness of their hearts lmao.
The reason they would pay for wegovy and not ozempic is because there’s specifically an indication for obesity for it. It was a way for eli lily (?) to charge more for the drug since there’s a dose dependent side effect of losing weight.
So they found a way to charge patients more and find a way that insurance companies wouldn’t just “prefer” or cover a drug like victoza or Bydureon. This is the reason they got that indication at all. They became the only drug for a short amount of time approved solely for weight loss.
Now that it’s one of like 3 drugs with tirzepatide or mounjaro and zepbound, they have a bit more competition. But it’s still the reason they allow it. Some plans still don’t because they haven’t run a cost analysis yet, but almost every plan I’ve encountered will cover one or another through PA, provided the patient has tried diet and weight loss for a few months minimum prior to that.
You stated insurance companies wouldn’t pay for Ozempic 0.25 as they want you to increase the dose for weight loss. That’s just not true friend. Insurance companies for the most don’t care about patients, they care about their bottom line.
I agree with that. I didn’t mean for it to come off that way; I meant that the manufacturing company got the drugs approved for those separate indications despite only being different strengths in order to get insurance companies that will pay for the drug approved for weight loss to have a reason to charge them more money for it if that makes sense
Only way to know definitively is to look at their A1C, glucose, other labs, weights, etc. Call the prescriber, discuss, and document. At some point, we have to acknowledge that some things are being used off-label.
If the patient is experiencing benefits, then let sleeping dogs lie.
This is what’s so annoying about some of my colleagues in a hospital pharmacy.
Like yes barb, I know the lisinopril is not at goal for hypertension. But they’ve been on the 10 mg dose for years, don’t have albuminurea, we don’t need to call the physician to increase it to 20 with a goal of 40; this patient just needs it for htn, and their BP is below the goal BP. Just leave it alone
But no they call the doctor then *shocked pikachu* when the doctor doesn’t want to increase the dose of a med that’s working lmao
If it’s working for the patient, what makes that ineffective? The provider wouldn’t keep prescribing it if it wasn’t working, unless they want the pt to try it for a specific amount of time before escalating the dose or switching them to something else.
Source: tech that does auths for GLP-1s.
Some pharmacists (and physicians/nurses/ all healthcare professionals) cannot comprehend humans are dynamic creatures and can only imagine treating off a guideline rather than looking at each specific patient as their own machine with different sized cogs and whistles and maintenance issues
It’s not an ineffective dose for everyone and some people, once they’ve met their weight and a1c goals, find this works well for them as a maintenance dose.
2.4mg is the maintenance dose for Wegovy and it actually says to d/c if patient can’t tolerate that dose, which is absurd. Plenty of benefit is seen at lower strengths of all these medications.
Every patient has a different effective dose, because human bodies are not uniform. The dosages provided are based on how the majority of trial participants responded, but when you broaden usage from a trial to the general public, effective levels that are infrequently seen in the trials can still represent a large number of potential patients.
Also, increasing dosage increases risk and severity of side effects. Some people who can't handle the side effects of a full dose may revert to a lower dose if it shows some level of results. I have a friend who's experiencing that. The side effects were too strong for her at the full 2mg dose, so her doctor dropped her back to the 1mg (after trying lower amounts using the 2mg syringes), and she can tolerate that. She'd probably get stronger results with the full dose, but she's satisfied with what she's getting now.
I actually started seeing significant results (both with blood sugar and weight) while I was still on the 0.25mg dose. I went ahead with the standard titration schedule because the effect wasn't as strong as my doctor and I wanted, and I wasn't seeing any significant side effects. But I could have stayed at a lower dose and still gotten positive results.
The studies the proved these medication work say that it doesn’t. I haven’t been able to find a single study showing efficacy of 0.25mg of semaglutide.
Ozempic isn’t the only GLP-1. Trulicity, Mounjaro, Victoza, and even Bydureon at their lowest dosages would likely produce better outcomes for these patients. They may even be able to tolerate a higher dose of one of these and much better off than if they just stayed on 0.25 mg Ozempic. If this were any other medication where a patient failed to tolerate titration to a treatment dose you would… try another medication. It’s just bad practice imo. We go the pharmacy school for 4 years learning how to back up our opinions and decisions on clincial studies and evidence, but I guess it’s different when it comes to the all mighty Ozempic.
You haven't found a study. But have you asked a patient? Don't always go by the literature as gospel and discount patient experience. Just because data can be anecdotal doesn't mean it's wrong. 25 years in Pharmacy here, and my husband is one of the "0.25 people." He uses Ozempic for glycemic control and has tried titration to a higher dose but gets too many side effects. Before the Ozempic, his blood sugar was not well controlled to spite countless attempts at different long/short term insulin combinations. The 0.25 stabilizes his sugar at around 12 (Canadian here). His insulin does the rest, and I might note, he requires a much lower dose of insulin this way too.
If you're fresh out of school, the one thing I'd like to impart to you is that "people aren't textbooks." Talk to them, talk to some endocrinologists, find out their experience, and make an informed decision then. Our job is helping people. So don't leave them out of the equation when forming your opinions.
My a&p professor loved to teach from the textbook for the whole year and then toss a bunch of oddities at the end just to prove that point.
When you hyperfocus on the structure of the kidneys from the textbook and then have a horseshoe kidney tossed at you it can really fuck you up.
The 0.25 mg dose can be enough for some patients to reach there BG goal. I've put patients on it that I didn't really want to lose weight but needed something safer or more convenient than insulin.
As a T2D pharmacy worker, sometimes patients can’t tolerate more than the initial dose. I’ve tried Trulicity, Ozempic, and Mounjaro for my Type 2, but I got horribly sick on all 3. I never made it past the initial dosing.
Yeah the GI side effects of these meds are brutal for some patients, which is unfortunate because they do work well. I’m all for it if all a patient can tolerate is 0.25mg Ozempic and they are meeting glycemic/weight loss goals. It’s frustrating to see these doctors not even attempt a different GLP-1 for all of the ones in my queue right now.
I had a pt lose lbs and BGs in normal range within the first month on the 0.25 mg dose. There wasn’t a need to go up to 0.5 mg dose. We tried it anyway and he said he started losing too much weight and started skipping meals so we back to 0.25 mg and he was good.
Who cares? Just fill the script and move on, what difference does it make? Are you going to step in and try and make an intervention regarding their glycemic control? If not, don't let it occupy your mind. Everyone needs to get over caring so much about these drugs. It's supply and demand and you aren't allowed to play gatekeeper so who cares?
Mind you they literally just asked a question. this isnt even a common long term dose, and so insurance wouldn't even pay for it, and its their job to ask questions if they think something is off because this isnt even a therapeutic dose according to the company. Just bc tbey arent throwing ozempic at our faces when we walk to the pharmacy doesn't mean they are a gatekeeper. This post has clinical education and Im tired of how people act so aggressive when it comes to this drug. Yes it has benefits but talk about side effects or proper doses and suddenly its a war. The drug does cause mood swings so makes sense. Its a common and popular drug nowadays so yeah you will see more people care about these drugs than like desiccated thyroid glands
i take 1ml a week for diabetes
and there is legit no difference in weight personally its sad that people using a diabetic medication to loose weight when we only die if we run out.
Respectfully, no one is going to die from running out of Ozempic, and yeah I'm T2 too. There are other options for us for glucose control if needed. It's not like insulin for T1s. And the medication in Ozempic, Semaglutide, is legitimately prescribed as Wegovy or compounded semaglutide specifically for weight loss because obesity is as much a chronic disease as T2 diabetes. Ozempic is also legitimately prescribed for cardiac protection and now for people with chronic kidney disease. Our disease is not somehow more deserving of treatment than those. It's too bad the pharmaceutical companies pushed advertising to drum up demand way beyond what they could actually supply but it's not the fault of any patients. These GLP-1s are amazing revolutionary drugs for a multiplicity of serious chronic conditions all of which deserve treatment. People trying to lose 5 lbs and celebrities aren't getting name brand - they can't come close to meeting rx requirements. They're going to med spas and getting compound which has exactly zero effect on the supply of branded medication for those who qualify. The shortage there is not the medication either, it's the parts for the pen delivery systems and again is absolutely the fault of the manufacturers so let's stop tearing people with chronic diseases up over what is caused by corporate greed and ineptitude.
These meds are aids, not maintenance, when it comes to weight loss. Higher doses come with more rebound and withdrawal cravings.
These people who push through the aid the drug gives and hit max dose aren't ever getting off the drug or seeing success.
I have patients that routinely do well with weight loss velocities of 1 lb/week on ozempic 0.25, 0.5, or zep bound 2.5. Unfortunately insurance often stops paying after 1-2 months unless I increase the dose.
Wegovy and Ozempic require dose escalation, but Zepbound has made changes allowing patients to stop at any dose and use it for maintenance. Insurance companies are following this new guideline, providing a significant advantage over Wegovy and Ozempic.
Yeah, it’s hard to pinpoint exactly which ones. I’ve seen that Express Scripts requires dose escalation for Wegovy. most will come around in the near future if havent yet
To ensure insurance coverage for Wegovy, you need to titrate up through the doses and cannot stop until reaching one of the higher doses.
In contrast, Zepbound allows for dose escalation to any dose, and you can remain on that dose, providing a significant advantage. If you’re paying out of pocket, this difference doesn’t apply.
If a patient has been on Wegovy 0.25mg for several months and has been covered , it is likely that the insurance will eventually require the patient to increase the dose to align with the prescribing guidelines. If the patient does not increase the dose, the treatment will be considered off-label, potentially leading to coverage issues.
Again cash payers no issue
I’ve started to see insurance rejections for patients that don’t titrate up. Like others said the higher doses come with unpleasant side effects for some. If a provider wants to submit PAs for “maintenance” use then there’s not much pharmacies can do. Can’t remember which GLP I saw a commercial for recently but the crux of the ad was that “weight loss is health care” which is a point of debate. I just feel bad for the patients that use it for diabetes/lowering A1C.
You make a valid point, which underscores the importance of using medications as intended. For weight loss, it’s crucial to use Wegovy or Zepbound, and for diabetes, Mounjaro or Ozempic. People using Mounjaro and Ozempic off-label for weight loss, despite having the same active ingredient, could face significant issues.
The 0.25 mg of Ozempic is not an FDA approved dose for that medication. The scripts you are filling are not being used to treat diabetes at that dose. We know this because it is not FDA approved at that dose. I would get the directions changed or not fill the 0.25 mg dose. If they get audited you will lose that money period. I know a pharmacist that this happened too. Even with the doctors notes and the insurance filling the script, they took back the money. Went to 3 appeals and he lost every one. It is bad ideal to fill at lower dose even if they get the PA.
0.25 mg can be effective for treating diabetes.
https://diabetesjournals.org/care/article/39/2/231/37200/A-Phase-2-Randomized-Dose-Finding-Study-of-the
There’s got to be something more to this than that, He was probably filling it for a 28 day supply instead of a 42 day.
If this was true then no one can stay on lower doses of Wegovy because the FDA only approved 2.4mg for maintenance and the PI says to titrate up each month and D/C if patient can’t tolerate 2.4mg. Obviously real world patients don’t all go up to 2.4, and obviously real world patients don’t D/C all together if they can’t tolerate 2.4mg.
If they're losing weight at that dose I don't see why you would increase it until you needed to.
No critical thinking skills is the problem here.
I know some GPs are also suggesting that if someone is at a weight they need to be at, continuing a low dose helps keep that weight gain from happening. I think it's like 15% weight is gained back if you stop ozempic/wegovy, even if you continue your current lifestyle mods. (this is off the top of my head so don't quote me. I know there are studies, look at those instead of a random lady on reddit!)
Thank you. My god, this is what separates us from robots/AI that can't do anything but regurgitate the guidelines and package inserts. If a drug is showing results and the patient is tolerating it, why would you increase to something they may not be able to tolerate?
And it might even be better if the lower dose is also causing them to lose weight if its happening slower. Give their body more time to adjust and reabsorb the excess skin and avoid "ozempic face" and other areas where loose skin can accumulate.
I don’t understand why doctors have so much power to prescribe anything and get away with it while we get written up for incorrect refills amount of some shit
The 0.25-mg dose can be effective at appetite suppression (weight loss) for much longer than the four weeks the official presribing label indicates. A lot of people will stay at 0.25 mg/week for as long as it remains effective -- many months -- and only increase when that dose is no longer sufficient to control appetite. While this doesn't adhere to the official prescribing info, there's really no need to increase the dose if the current dose is working. Especially since increasing the dose also tends to increase adverse effects like nausea and constipation.
Interesting to know, I haven’t really had the opportunity to discuss how it’s been working for them at that dose. Saw one with a stop in adjudication to get verification from provider on continuation of 0.25mg dose about an hour before close today but didn’t have any previous notes on file. It was slow and I was curious, and I ended up finding a few more in my contact queue that still needed followed up on. I wasn’t able to find any studies showing efficacy of that dose for weight loss or glycemic control, so I made this post to see if my initial thoughts were misguided.
https://diabetesjournals.org/care/article/39/2/231/37200/A-Phase-2-Randomized-Dose-Finding-Study-of-the This shows 0.2 mg is more effective than placebo in terms of glycemic control. On top of that, we know Ozempic is effective for both diabetes and obesity. Just because the company didn’t pursue a dosing strategy incorporating 0.25 doesn’t mean that dose can’t be effective. It shouldn’t be a big surprise that some Ozempic can be better than no Ozempic,
This is interesting because it actually kind of goes along with a comment I was just writing up. If the manufacturer says the discontinue the medication if a patient fails initial dose titration, why is the answer to stay on that medication? Just a Quick Look at what you linked the 1.2mg Victoza lowered A1c further than 0.4mg Ozempic. Maybe the patient being kept on 0.25 Ozempic can tolerate 1.2mg Victoza, but we can’t know because these doctors aren’t trying.
Who is saying the patient failed the titration? I am not exactly following your point but I would only continue Ozempic 0.25 mg if the patient was meeting their glycemic and weight goals and that happens fairly often especially in newly diagnosed diabetics. Otherwise I would change GLPs. I would probably not try Victoza unless insurance required it due to it being daily and poorly tolerated especially compared to the weekly formulations.
Sorry, I guess it wasn’t very clear in my initial post. What I’m talking about is these doctors that are okaying these 0.25mg continuations without even attempting a different GLP-1, especially if they already weren’t controlled on oral meds. Maybe it’s the doctors offices around me, tele docs not giving a shit, or I got lucky and only looked at the bad examples at work today. Maybe I’m thinking like I’m still in school too much. Who knows. I wouldn’t suggest Victoza either, im surprised I still have patients on it considering the alternatives. That’s just what the linked study used as a comparator to semaglutide.
Well if you know they are not controlled on the regimen, that would be annoying and negligent knowing they are on only Ozempic 0.25. But if they are controlled I can understand the lack of inertia to titrate Ozempic and discontinue other meds/optimize the regimen.
Yep, plus; if someone isn’t building actively healthy habits with the appetite suppression, it’s an early indicator that these drugs won’t work in the long run. They’ll benefit for the time being so if they can pay or want to pay then sure. But no reason to put them through a potentially life disrupting GI ADRs from increasing to a harder to tolerate dose without initiating that CBT necessary to maintain long lasting healthy lifestyle habits
Would be nice if they started including 8 needles per box so patients aren’t trying to figure out what to do for the extra 2 doses
Yeah that’s also an issue but you can just buy a box of 100 pen needles and be good for a few years lol. At least the BUD for the pens are 56 days.
It dose not come with 8 pens because it is not FDA approved to take the 0.25 weekly.
This is my thing. The manufacturer recommend that 0.25b isn't a therapeutic dose. I'm just not understanding where people are saying "use clinical thought process". You going to keep a patient on a dose that may or may not be therapeutic for weight loss and if it's not they are stuck with 2 or 1 dose. But actually as I was typing I guess if they go up to 0.5, they'll technically have 2 extra pen needles in the next box? Just use those and no wasted doses. If there staying on 0.25 then just prescribe extra needles? Idk it just feels weird using such a low dose and going against a manufacturer recommendation. Personally I've never seen any one we have put on either victoza or ozempic have any success on the lowest "titration" dose. And we were churning out ozempic scripts when the boom started and it was still 340b pricing, but that's also personal and anecdotal so.
The issue is that specifically victoza has less weight loss effect overall, and it’s very easy for people to take ozempic or wegovy and have really bad GI ADRS that could take a couple weeks for the body to get used to. On top of that; I’ve seen some physicians like to schedule a nutritionist meeting with the patient to develop a weight loss regimen, and develop healthier eating habits before going up to the therapeutic doses so that the weight loss can stick. Obviously this is also anecdotal; but just a thought as to why some physicians may be keeping patients having a harder time at a sub therapeutic dose if they’re transitioning/waiting on other appointments, that way they’ll have the largest affect once they get that therapeutic dose but will also be able to more readily tolerate the higher dosage without wanting to quit because they may or may not shit their intestines out metaphorically lmao
I had a pt that claimed the 0.5 mg gave her a racing heart. She had the doctor change the dose for her next month's fill and that was fine by me.
My only issue is with the ozempic and the day supply. Most insurances won’t pay for the 56 days supply at 0.25mg weekly with the 3ml pen, and I’m sure an audit by most insurances would result in a loss if it’s billed for 30 days.
Anyone who haa gone through audits on either side able to shed light? If ins limits to 30ds (which also means the intended 42 ~~week~~ day supply is not "approved"), but we're only dispensing a 3ml pen every 8 weeks, does that actually have merit on clawbacks? I can understand, certainly, if we kept filling 0.25mg/week directions and dispensed 12 boxes in a year that pbms have a cause there for taking back on audit. But if only 6 boxes in a year, dispensinf every other month, I don't see how the insurance was paying for too much.
I did the chargebacks for a large chain pharmacy for 22 years. If you annotate on Rx when typing cannot break open box so must bill for 28 days … insurance covers it no chargeback . Since we don’t break open Ozempic , it’s similar to other package like eye drops , maybe it’s a 80 day supple as written but they are only using for 14 days and insurance doesn’t cover over 30, wee annotate for 14 days and bill for actual use … see it a lot on eye drops for eye procedures
It’s wild that insurance wants the patient to use more Ozempic. I would think they would be happy to pay for less. And yes, patients absolutely can have benefit at a dose of 0.25 mg.
Insurance companies must adhere to the prescribing information based on clinical trial data, as these guidelines dictate the required dosage increases. While prescribers can opt for off-label use (stay on same dose) , insurance companies potentially will cut coverage if guidelines are not followed. This restriction does not apply if you’re paying out of pocket.
It’s because weight loss saves them money in the long run. It’s a catch 22. They don’t care as long as the patient is using it because they’ve calculated that with the weight loss predicted they could potentially save millions yearly if every single person over bmi with an insurance plan with them were on it
That’s an interesting take as Ozempic is usually denied in favor of Wegovy if I’m prescribing for obesity and many insurance plans, including Medi-Care do not pay for weight loss medications.
It’s not an interesting take it’s the reason that any insurance company would actually pay for such a medication. They don’t pay out of the goodness of their hearts lmao. The reason they would pay for wegovy and not ozempic is because there’s specifically an indication for obesity for it. It was a way for eli lily (?) to charge more for the drug since there’s a dose dependent side effect of losing weight. So they found a way to charge patients more and find a way that insurance companies wouldn’t just “prefer” or cover a drug like victoza or Bydureon. This is the reason they got that indication at all. They became the only drug for a short amount of time approved solely for weight loss. Now that it’s one of like 3 drugs with tirzepatide or mounjaro and zepbound, they have a bit more competition. But it’s still the reason they allow it. Some plans still don’t because they haven’t run a cost analysis yet, but almost every plan I’ve encountered will cover one or another through PA, provided the patient has tried diet and weight loss for a few months minimum prior to that.
You stated insurance companies wouldn’t pay for Ozempic 0.25 as they want you to increase the dose for weight loss. That’s just not true friend. Insurance companies for the most don’t care about patients, they care about their bottom line.
I agree with that. I didn’t mean for it to come off that way; I meant that the manufacturing company got the drugs approved for those separate indications despite only being different strengths in order to get insurance companies that will pay for the drug approved for weight loss to have a reason to charge them more money for it if that makes sense
I have a patient taking 0.25mg weekly and her A1c has been at goal for months. She can’t tolerate anything higher
For weight loss or DM?
Obviously DM
The number one rule for any pharmacy graduate is to never assume and always clarify. I appreciate it.
Only way to know definitively is to look at their A1C, glucose, other labs, weights, etc. Call the prescriber, discuss, and document. At some point, we have to acknowledge that some things are being used off-label. If the patient is experiencing benefits, then let sleeping dogs lie.
This is what’s so annoying about some of my colleagues in a hospital pharmacy. Like yes barb, I know the lisinopril is not at goal for hypertension. But they’ve been on the 10 mg dose for years, don’t have albuminurea, we don’t need to call the physician to increase it to 20 with a goal of 40; this patient just needs it for htn, and their BP is below the goal BP. Just leave it alone But no they call the doctor then *shocked pikachu* when the doctor doesn’t want to increase the dose of a med that’s working lmao
But whine whine whine “off label” whine whine.
If it’s working for the patient, what makes that ineffective? The provider wouldn’t keep prescribing it if it wasn’t working, unless they want the pt to try it for a specific amount of time before escalating the dose or switching them to something else. Source: tech that does auths for GLP-1s.
Sometimes my patients simply cannot tolerate more than the initial dose to be completely honest.
Some pharmacists (and physicians/nurses/ all healthcare professionals) cannot comprehend humans are dynamic creatures and can only imagine treating off a guideline rather than looking at each specific patient as their own machine with different sized cogs and whistles and maintenance issues
It’s not an ineffective dose for everyone and some people, once they’ve met their weight and a1c goals, find this works well for them as a maintenance dose.
2.4mg is the maintenance dose for Wegovy and it actually says to d/c if patient can’t tolerate that dose, which is absurd. Plenty of benefit is seen at lower strengths of all these medications.
Every patient has a different effective dose, because human bodies are not uniform. The dosages provided are based on how the majority of trial participants responded, but when you broaden usage from a trial to the general public, effective levels that are infrequently seen in the trials can still represent a large number of potential patients. Also, increasing dosage increases risk and severity of side effects. Some people who can't handle the side effects of a full dose may revert to a lower dose if it shows some level of results. I have a friend who's experiencing that. The side effects were too strong for her at the full 2mg dose, so her doctor dropped her back to the 1mg (after trying lower amounts using the 2mg syringes), and she can tolerate that. She'd probably get stronger results with the full dose, but she's satisfied with what she's getting now. I actually started seeing significant results (both with blood sugar and weight) while I was still on the 0.25mg dose. I went ahead with the standard titration schedule because the effect wasn't as strong as my doctor and I wanted, and I wasn't seeing any significant side effects. But I could have stayed at a lower dose and still gotten positive results.
“Ineffective dose” should actually be based on if it’s working, not what the drug company says the dose should be.
The studies the proved these medication work say that it doesn’t. I haven’t been able to find a single study showing efficacy of 0.25mg of semaglutide. Ozempic isn’t the only GLP-1. Trulicity, Mounjaro, Victoza, and even Bydureon at their lowest dosages would likely produce better outcomes for these patients. They may even be able to tolerate a higher dose of one of these and much better off than if they just stayed on 0.25 mg Ozempic. If this were any other medication where a patient failed to tolerate titration to a treatment dose you would… try another medication. It’s just bad practice imo. We go the pharmacy school for 4 years learning how to back up our opinions and decisions on clincial studies and evidence, but I guess it’s different when it comes to the all mighty Ozempic.
You haven't found a study. But have you asked a patient? Don't always go by the literature as gospel and discount patient experience. Just because data can be anecdotal doesn't mean it's wrong. 25 years in Pharmacy here, and my husband is one of the "0.25 people." He uses Ozempic for glycemic control and has tried titration to a higher dose but gets too many side effects. Before the Ozempic, his blood sugar was not well controlled to spite countless attempts at different long/short term insulin combinations. The 0.25 stabilizes his sugar at around 12 (Canadian here). His insulin does the rest, and I might note, he requires a much lower dose of insulin this way too. If you're fresh out of school, the one thing I'd like to impart to you is that "people aren't textbooks." Talk to them, talk to some endocrinologists, find out their experience, and make an informed decision then. Our job is helping people. So don't leave them out of the equation when forming your opinions.
My a&p professor loved to teach from the textbook for the whole year and then toss a bunch of oddities at the end just to prove that point. When you hyperfocus on the structure of the kidneys from the textbook and then have a horseshoe kidney tossed at you it can really fuck you up.
The 0.25 mg dose can be enough for some patients to reach there BG goal. I've put patients on it that I didn't really want to lose weight but needed something safer or more convenient than insulin.
Same. I’ve had patients BGs tank when starting 0.25mg many times. I always pre-emptively reduce insulin now when initiating.
Yeah, I found that people who stay on that dose are normally those taking it for weight loss....but I mean if it's working, why change it?
As a T2D pharmacy worker, sometimes patients can’t tolerate more than the initial dose. I’ve tried Trulicity, Ozempic, and Mounjaro for my Type 2, but I got horribly sick on all 3. I never made it past the initial dosing.
Yeah the GI side effects of these meds are brutal for some patients, which is unfortunate because they do work well. I’m all for it if all a patient can tolerate is 0.25mg Ozempic and they are meeting glycemic/weight loss goals. It’s frustrating to see these doctors not even attempt a different GLP-1 for all of the ones in my queue right now.
I had a pt lose lbs and BGs in normal range within the first month on the 0.25 mg dose. There wasn’t a need to go up to 0.5 mg dose. We tried it anyway and he said he started losing too much weight and started skipping meals so we back to 0.25 mg and he was good.
Who cares? Just fill the script and move on, what difference does it make? Are you going to step in and try and make an intervention regarding their glycemic control? If not, don't let it occupy your mind. Everyone needs to get over caring so much about these drugs. It's supply and demand and you aren't allowed to play gatekeeper so who cares?
Mind you they literally just asked a question. this isnt even a common long term dose, and so insurance wouldn't even pay for it, and its their job to ask questions if they think something is off because this isnt even a therapeutic dose according to the company. Just bc tbey arent throwing ozempic at our faces when we walk to the pharmacy doesn't mean they are a gatekeeper. This post has clinical education and Im tired of how people act so aggressive when it comes to this drug. Yes it has benefits but talk about side effects or proper doses and suddenly its a war. The drug does cause mood swings so makes sense. Its a common and popular drug nowadays so yeah you will see more people care about these drugs than like desiccated thyroid glands
Not 0.25 but me and my doctor agreed we were gonna stay at 0.5 mg because the higher doses give me gastroparesis.
I keep patients on 0.25mg dose as long as I can with them losing weight. I only increase the dose if they have zero weight lose in 2-3 weeks
i take 1ml a week for diabetes and there is legit no difference in weight personally its sad that people using a diabetic medication to loose weight when we only die if we run out.
How do you think people avoid becoming a diabetic in the first place?
Respectfully, no one is going to die from running out of Ozempic, and yeah I'm T2 too. There are other options for us for glucose control if needed. It's not like insulin for T1s. And the medication in Ozempic, Semaglutide, is legitimately prescribed as Wegovy or compounded semaglutide specifically for weight loss because obesity is as much a chronic disease as T2 diabetes. Ozempic is also legitimately prescribed for cardiac protection and now for people with chronic kidney disease. Our disease is not somehow more deserving of treatment than those. It's too bad the pharmaceutical companies pushed advertising to drum up demand way beyond what they could actually supply but it's not the fault of any patients. These GLP-1s are amazing revolutionary drugs for a multiplicity of serious chronic conditions all of which deserve treatment. People trying to lose 5 lbs and celebrities aren't getting name brand - they can't come close to meeting rx requirements. They're going to med spas and getting compound which has exactly zero effect on the supply of branded medication for those who qualify. The shortage there is not the medication either, it's the parts for the pen delivery systems and again is absolutely the fault of the manufacturers so let's stop tearing people with chronic diseases up over what is caused by corporate greed and ineptitude.
Damo it’s paul w4lsh u need to message me on here
These meds are aids, not maintenance, when it comes to weight loss. Higher doses come with more rebound and withdrawal cravings. These people who push through the aid the drug gives and hit max dose aren't ever getting off the drug or seeing success.
Unfortunately, these medications are intended for chronic, lifelong use.
Do they have a fairly low co-pay? Resale value is pretty high on these, especially the starting packs everyone wants.
Yea but it would be more profitable at 0.5 q week. 0.25 means I'm putting 56 days supply and some pts have two months copay.
I have patients that routinely do well with weight loss velocities of 1 lb/week on ozempic 0.25, 0.5, or zep bound 2.5. Unfortunately insurance often stops paying after 1-2 months unless I increase the dose.
Wegovy and Ozempic require dose escalation, but Zepbound has made changes allowing patients to stop at any dose and use it for maintenance. Insurance companies are following this new guideline, providing a significant advantage over Wegovy and Ozempic.
That’s great to know. Is that true of most major carriers?
Yeah, it’s hard to pinpoint exactly which ones. I’ve seen that Express Scripts requires dose escalation for Wegovy. most will come around in the near future if havent yet
Thanks for the info!
To ensure insurance coverage for Wegovy, you need to titrate up through the doses and cannot stop until reaching one of the higher doses. In contrast, Zepbound allows for dose escalation to any dose, and you can remain on that dose, providing a significant advantage. If you’re paying out of pocket, this difference doesn’t apply. If a patient has been on Wegovy 0.25mg for several months and has been covered , it is likely that the insurance will eventually require the patient to increase the dose to align with the prescribing guidelines. If the patient does not increase the dose, the treatment will be considered off-label, potentially leading to coverage issues. Again cash payers no issue
"seems dumb" but also has little or no context of whats actually happening
I'll tell you one thing - better be billing that 0.25mg dose of Ozempic for 42 days or Optum will get you.
So only issue I've seen is some instances are charging double if I bill it as a 56 day supply.
I’ve started to see insurance rejections for patients that don’t titrate up. Like others said the higher doses come with unpleasant side effects for some. If a provider wants to submit PAs for “maintenance” use then there’s not much pharmacies can do. Can’t remember which GLP I saw a commercial for recently but the crux of the ad was that “weight loss is health care” which is a point of debate. I just feel bad for the patients that use it for diabetes/lowering A1C.
You make a valid point, which underscores the importance of using medications as intended. For weight loss, it’s crucial to use Wegovy or Zepbound, and for diabetes, Mounjaro or Ozempic. People using Mounjaro and Ozempic off-label for weight loss, despite having the same active ingredient, could face significant issues.
The 0.25 mg of Ozempic is not an FDA approved dose for that medication. The scripts you are filling are not being used to treat diabetes at that dose. We know this because it is not FDA approved at that dose. I would get the directions changed or not fill the 0.25 mg dose. If they get audited you will lose that money period. I know a pharmacist that this happened too. Even with the doctors notes and the insurance filling the script, they took back the money. Went to 3 appeals and he lost every one. It is bad ideal to fill at lower dose even if they get the PA.
0.25 mg can be effective for treating diabetes. https://diabetesjournals.org/care/article/39/2/231/37200/A-Phase-2-Randomized-Dose-Finding-Study-of-the
There’s got to be something more to this than that, He was probably filling it for a 28 day supply instead of a 42 day. If this was true then no one can stay on lower doses of Wegovy because the FDA only approved 2.4mg for maintenance and the PI says to titrate up each month and D/C if patient can’t tolerate 2.4mg. Obviously real world patients don’t all go up to 2.4, and obviously real world patients don’t D/C all together if they can’t tolerate 2.4mg.