INTRO: Ready to Take Charge

I've been using prescription Tirz for roughly 18 months, and the results for my health and overall life have been fantastic. However, actually getting the medication has been an almost endless fight. It began with doctors who held personal biases and weren't properly informed, prices that are practically out of reach, and PBMs meddling in the health choices my doctor and I make. They demanded I spend months on entirely different drugs that didn't work, going against my doctor's advice, and then kept treating me as though I were trying to steal from them just because I want a medication my doctor prescribed that actually helps me. Nearly every month, when I try to fill the prescription, I've had to complete some new form or pull my doctor into the process, even though I already have a pre-approval that runs through mid 2027. As a result, I've gone weeks at a time without my meds. All of these problems will soon be irrelevant, because starting in 2027, changes to my insurance plan's policy will push the cost from "near unattainable" to simply unattainable. That's the reason I'm here: to take control.

Welcome! I completely understand your frustration. Our insurance provider just told us that starting in January, the copay for GLP-1's will jump from $25 to $200. When I shared that with my MD, I thought he was going to have a stroke. We both work for the same health system (!), and neither of us could figure out why a health system of all places would choose insurance that covers the long-term consequences of obesity instead of paying for the medications that help combat obesity.

Best of luck on your journey!

LetsGoWolves said:

Welcome! I completely understand your frustration. Our insurance provider just told us that starting in January, the copay for GLP-1's will jump from $25 to $200. When I shared that with my MD, I thought he was going to have a stroke. We both work for the same health system (!), and neither of us could figure out why a health system of all places would choose insurance that covers the long-term consequences of obesity instead of paying for the medications that help combat obesity.

Best of luck on your journey!

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Over the last few weeks, I've come across this exact same news repeatedly: the deductible climbing from $25 to $200, plus a 15-30% bump in the annual premium. My take is that they couldn't care less about the long-term expenses of obesity — that's a problem for some future shareholders, while they're focused on pushing the stock price up right now. Certainly some portion of people will end up dropping treatment, but with the copay at 8x, they'll still be pulling more money from everyone who stays on.

Big Pharma increasingly comes across like street-level drug dealers to me. They don't seem to care about the people using their products or how dependent those people are on what they sell — the only thing that matters is profit. I suppose that's just capitalism, but keeping up with the financial pressure of everyday life is really tough.

To be honest, a large share of the problems in US healthcare can be linked straight to how much influence insurance companies have grabbed for themselves — and, to a smaller but growing extent, pharmacy benefit management companies.

After 20+ years working in a hospital, it's almost hard to believe how much practice has changed compared with when I began. The biggest force behind most of those changes — particularly the bad ones — is what insurance does and doesn't pay for, along with pharmacies being pushed to take a loss in order to fill certain prescriptions. I could keep listing examples, but I won't take over your welcome thread any further.