We have talked about weight-loss medications a great deal – the ins and the outs, what to expect and all the potential side effects. However, one question that keeps coming up, and I have yet to address, is how does one go about getting on one of these medications?!
Yeah, thanks for all the information BUT how do I get these medications?
First and foremost, a vast majority of the current Obesity medications on the market require a prescription from a doctor and then a visit to the pharmacy. Xenical or Orlistat might be the only exception.
It is currently sold under the brand name Alli and is at a lower dose compared to what is found in Xenical. I believe you can buy Alli at pharmacies in the US and maybe even online? Don’t hold me to that as I have not looked that deep into the situation given Orlistat might lead to some situations that could be quite sh*tty, which I will review in a future blog. Outside of that the rest require a prescription and if anyone is saying they can sell you it without they are trying to scam you.
So, how does one get their doctor to prescribe them a weight-loss medication such as Saxenda or Wegovy?
There are a couple of factors we need to look at here.
First, your doctor needs to determine if the medication is even indicated for you. These medications are indicated and approved by the FDA and Health Canada for use in Obesity.
Obesity in these situations is defined as a BMI >30.0 or a BMI >28.0 with obesity-related comorbidities such as diabetes, high blood pressure, etc. So if the drug is indicated they need to determine if it’s safe, i.e. you won’t have any issues metabolizing the drug – are your kidneys and/or liver intact, do you have any other medical history that would prevent you from being on the drug. In the case of the GLP-1 receptor agonists, this would be things like a history or family history of Medullary Thyroid Carcinoma (MTC).
If the above criteria are met and your physician is comfortable prescribing the medication – i.e. they know what it does and how to monitor it, they will likely prescribe it. OR they might refer you to a specialist to prescribe it if they don’t feel comfortable with it.
In some cases, I have heard physicians denying patients a prescription as they feel they just need to ‘eat less and move more’, ‘push the plate away’, or ‘just stop being lazy’ and the problem would be solved.
Ground-breaking revelations, I know. Obviously, that isn’t the case in every situation and for some, the medication would not be indicated or perhaps a trial of non-pharmacological modalities needs to be initiated first. There could be a plethora of reasons, and while I have been trying to clone myself, I am unable to be in every doctor’s office for every appointment to hear the specific conversation or thought process. Thinking about it, that might be a bit creepy for all parties involved. Ok, enough about me violating your privacy…
What if I don’t technically have Obesity based on the BMI?
Yes, the BMI is not a very effective metric. So perhaps you have a BMI that is below the cut-offs, yet you still have some excess adipose tissue that is posing a health risk – as this is the true definition of obesity.
In these situations, it is all going to depend on your doctor. The reason being is that if these medications are prescribed and you don’t meet the above criteria, THEN it is considered off-label prescribing. Similarly, when it comes to prescribing Ozempic for weight-loss and you don’t have diabetes this is considered off-label as Ozempic is technically ONLY indicated for use in diabetes.
Even though Wegovy is also on the market, it has the exact same drug in it as Ozempic (semaglutide). I know, it is all very stupid. So off-label prescribing does have some inherent risks for the prescriber, i.e. If a patient experiences an adverse event and is prescribed a drug off-label, it could mean some hot water for the clinician. So, your doctor has to be comfortable with it and be confident that the benefits outweigh the risks.
What about insurance? Are these drugs covered?
Aka, the next big hurdle or probably the biggest and dumbest: insurance companies.
They will have piles of paperwork for both you and your physician to complete. Not even one time will they provide coverage for a drug that is being prescribed off-label. Even if you 100% satisfy their criteria, the wind might blow and they may decide to deny you coverage.
You see, their job isn’t to insure you and make your life easier; their job is to make as much money as possible. And the only way they do that is by paying out the least amount of money possible. The number of special authorization forms and appeals I have had to write over the years is appalling and is likely only going to get worse.
Best wishes and kindest regards in that realm!
Final thoughts from Dr. Dan
Hopefully, this clears up a few things as to how an individual goes about obtaining these medications. Maybe one day we will live in a just and people-driven world instead of one driven by profits and bottom lines.
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Until next time, always remember small tweaks lead to massive peaks!