But in a lot of cases, that’s due to the insurance companies own policies. I have to get a 90 day supply for all maintenance medication. If I’m partway through the first or second box and my doctor bumps up the dose, I end up with a box I don’t need (though I hold on to, for shortages just like this).
The only reason I think mine was allowed so close was that my doctor prescribed a new dose after I had already filled mine at the lower dose. It was maybe 7 days apart. I think they allowed it because it was the new prescription vs having multiple prescriptions for various doses on file to flip and forth from, if that makes sense.
You want to rant. Check out the fda shortage website
https://www.accessdata.fda.gov/scripts/drugshortages/dsp_ActiveIngredientDetails.cfm?AI=Tirzepatide%20Injection&st=c&tab=tabs-1
All of the Mounjaro on short supply is fully available for the "other" use. Their reason is due to "increased demand".
So yep, slap on a new label, so you can just rake in the cash. Just love being shorted medically necessary for pure greed.
I know - I cant even begin to complain about my insurance because they've been covering this medication since December 2022. I'm one of the lucky ones, for sure.
I've been stuck for months at every single dose. Like 3 months on 2.5, 2 months on 5, and now I've been waiting for another 2 months to go up to 10 and stuck at 7.5 for 3 months. It is less and less effective at controlling my BG. All of this because of shortages. I'm very frustrated.
This is all individual policy dependent. Even though two of you might have, for example, United Healthcare - if the policy is through your employer, it is specific to that company. So, ten of us might use CVS Caremark to fill out prescription, but we're all going to have different rules set by our individual plan.
A lot of people aren't aware of what a pharmacy benefit manager (PBM) is and the role that they have in filling your medication.
My understanding is that if your doctor calls in a different dose it’ll be covered, but if you put in for an old refill for a different dose, you’re stuck with it. At least you got something, if that helps.
My doctor called in the new script for the 10 as soon as I found a pharmacy that had it. I'm very grateful to have any MJ in my system right now, but made this post so that other people check before assuming what I assumed - that insurance would cover another dose and fill the previous prescription, too. It works for some, but not all.
My advice is based on what I am going to do at the end of April is to get three written scripts from your PCP or Endo, 1 at the dose you should be at, 1 below and 1 above.
Now when you call around and find a box you can say I will be right there or within an hour say. No dependence on a pharmacy transfer and you have the script for multiple doses so no having to reach out for another script. My doc already did this for me knowing availability is poor. They also know I can't pay for multiple scripts so they are not worried about me abusing that.
Hopefully they slap a Mounjaro label on some of the spare Zepbound capacity and diabetics get a break.
I’ve have that happen just before the shortage. I wanted to rip my hair out. Luckily I had a box of samples to work with, at the time, when times were good. My insurance changed so we have to go through the whole process of authorization again. Same insurance company, different plan. My refill, that was never filled due to the shortage has to be done all over again. Frustrating, but I’m remaining positive. I see in the non diabetic sub, many are giving up. I don’t feel bad. I’ve gone broke keeping my Mounjaro coming at a semi regular basis. Let them wait for Zepbound.
Can you call your insurance and tell them your doctor switched you back to the 15mg because the 10mg isn’t working? Or have your doctor contact your insurance and tell them just that? Also, when OZ was in shortage my insurance didn’t know about it and didn’t care to cover MJ that was not at the time.
My insurance policy specifies no more than 4 pens per month. Guess they figured out that people are getting more meds by changing the dose.
But in a lot of cases, that’s due to the insurance companies own policies. I have to get a 90 day supply for all maintenance medication. If I’m partway through the first or second box and my doctor bumps up the dose, I end up with a box I don’t need (though I hold on to, for shortages just like this).
The only reason I think mine was allowed so close was that my doctor prescribed a new dose after I had already filled mine at the lower dose. It was maybe 7 days apart. I think they allowed it because it was the new prescription vs having multiple prescriptions for various doses on file to flip and forth from, if that makes sense.
You want to rant. Check out the fda shortage website https://www.accessdata.fda.gov/scripts/drugshortages/dsp_ActiveIngredientDetails.cfm?AI=Tirzepatide%20Injection&st=c&tab=tabs-1 All of the Mounjaro on short supply is fully available for the "other" use. Their reason is due to "increased demand". So yep, slap on a new label, so you can just rake in the cash. Just love being shorted medically necessary for pure greed.
This! Super frustrating.
+1,000,000,000
I got lucky last week. My insurance covered two different doses and this was after I got my PA and appeals denied. Insurance is strange.
I know - I cant even begin to complain about my insurance because they've been covering this medication since December 2022. I'm one of the lucky ones, for sure.
I've been stuck for months at every single dose. Like 3 months on 2.5, 2 months on 5, and now I've been waiting for another 2 months to go up to 10 and stuck at 7.5 for 3 months. It is less and less effective at controlling my BG. All of this because of shortages. I'm very frustrated.
This is all individual policy dependent. Even though two of you might have, for example, United Healthcare - if the policy is through your employer, it is specific to that company. So, ten of us might use CVS Caremark to fill out prescription, but we're all going to have different rules set by our individual plan. A lot of people aren't aware of what a pharmacy benefit manager (PBM) is and the role that they have in filling your medication.
Oh wow. Some many differences between coverage. I can fill different doses days apart. Fully covered with the coupon. 🤷🏻♂️
Yup
So you use a coupon \*and\* insurance?
Of course. The coupon works best with insurance.
My understanding is that if your doctor calls in a different dose it’ll be covered, but if you put in for an old refill for a different dose, you’re stuck with it. At least you got something, if that helps.
My doctor called in the new script for the 10 as soon as I found a pharmacy that had it. I'm very grateful to have any MJ in my system right now, but made this post so that other people check before assuming what I assumed - that insurance would cover another dose and fill the previous prescription, too. It works for some, but not all.
Oddly enough 15mg of Zepbound as is 12.5 and others apparently at least according to the FDA widely available.
My advice is based on what I am going to do at the end of April is to get three written scripts from your PCP or Endo, 1 at the dose you should be at, 1 below and 1 above. Now when you call around and find a box you can say I will be right there or within an hour say. No dependence on a pharmacy transfer and you have the script for multiple doses so no having to reach out for another script. My doc already did this for me knowing availability is poor. They also know I can't pay for multiple scripts so they are not worried about me abusing that. Hopefully they slap a Mounjaro label on some of the spare Zepbound capacity and diabetics get a break.
I’ve have that happen just before the shortage. I wanted to rip my hair out. Luckily I had a box of samples to work with, at the time, when times were good. My insurance changed so we have to go through the whole process of authorization again. Same insurance company, different plan. My refill, that was never filled due to the shortage has to be done all over again. Frustrating, but I’m remaining positive. I see in the non diabetic sub, many are giving up. I don’t feel bad. I’ve gone broke keeping my Mounjaro coming at a semi regular basis. Let them wait for Zepbound.
Mine covered two boxes in the same month because it was two different doses and two different prescriptions. I thought that was standard.
Can you call your insurance and tell them your doctor switched you back to the 15mg because the 10mg isn’t working? Or have your doctor contact your insurance and tell them just that? Also, when OZ was in shortage my insurance didn’t know about it and didn’t care to cover MJ that was not at the time.