From gray-market Semaglutide to doctor-prescribed Tirzepatide

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My wife began Semaglutide through the gray market, and now her doctor is recommending Tirzepatide.

The doctor doesn’t know she recently started Semaglutide, but we went over the pros and cons of both, and he prefers Tirzepatide for her. We’ve submitted a request to insurance for the Tirz, and I wanted to see if anyone has advice about making the switch. We won’t find out until the end of June whether insurance will cover Tirz for her.

Should she quit Sema now, even though it isn’t certain she’ll get Tirz through insurance? Or should I move her to Tirz now and transition to the doctor-prescribed version over the summer? Or might we have to remain gray if insurance denies it.

Any experiences or suggestions would be appreciated.
 
What's her progress with sema? When did she begin — 1 week back? 2 days? What dose is she on now?

What is she aiming for (e.g., how many pounds does she want to drop)? Any adverse effects? Has she shed any weight yet?

That said, overall tirz tends to be the superior pick. If nausea is or becomes a problem, there's less of it. Bloodwork improvements come better/faster. Weight comes off faster/more.

Here, most folks — me included — can't figure out why anyone would pick sema as a starting point nowadays. My doc felt the same, and he's the one who wrote the tirz script. Still, these are broad strokes, so the individual matters. Leftover sema is handy for stockpiling, though. It breaks down even more slowly than tirz, at least in theory.
 
Calm Logic said:

What's her progress with sema? When did she begin — 1 week back? 2 days? What dose is she on now?

What is she aiming for (e.g., how many pounds does she want to drop)? Any adverse effects? Has she shed any weight yet?

That said, overall tirz tends to be the superior pick. If nausea is or becomes a problem, there's less of it. Bloodwork improvements come better/faster. Weight comes off faster/more.

Here, most folks — me included — can't figure out why anyone would pick sema as a starting point nowadays. My doc felt the same, and he's the one who wrote the tirz script. Still, these are broad strokes, so the individual matters. Leftover sema is handy for stockpiling, though. It breaks down even more slowly than tirz, at least in theory.
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Two weeks have passed since she began. The dose is .5, split between Tuesday and Saturday. Our decision to go with Semaglutide came from knowing friends who did really well on Ozempic.

For 2 days following each injection, she deals with nausea.

The doctor echoed the same recommendation: Tirzepatide is the medication he prefers for her. Losing 20-25 lbs is her aim, along with improving her bloodwork, since her A1C consistently sits in the pre-diabetic range of 6-7. So far she's down 3 lbs, though that might simply reflect her being more mindful about what she eats, plus the nausea.

At this point I'm considering moving her to Tirzepatide within the week and continuing with gray for as long as necessary, because there's no telling whether insurance will ever pick up the cost.
 
I'd give sema a miss and go with grey tirz, though that could muddy the insurance picture. My insurer probably won't cover tirz for someone who's only pre-diabetic.
 
At .5, the sema dose might be excessive. Could she drop down to .25 weekly to check how she responds, until the Tirz prescription gets approved? And if insurance won't pay for Tirz, will you still obtain it?
 
SoCalGirl said:

At .5, the sema dose might be excessive. Could she drop down to .25 weekly to check how she responds, until the Tirz prescription gets approved? And if insurance won't pay for Tirz, will you still obtain it?
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Tonight I'm going to talk it over with her. Since I've spent a couple of years working with peptides, she relies on me to dig into the details. For my own GLP use, I jumped right to Reta. But because her friends had done well on Sema, it looked like a sensible first peptide for her, letting her compare how it went against their experiences.

Our primary doctor is the same for both of us, and yesterday I had an appointment with him. Her own visit with him is set for June. I brought up GLP-1 and asked what he thought, and given her full health history, he was strongly of the view that Tirz would be the better choice for her.

So my plan is to talk with her about whether she wants to switch, using his recommendation plus whatever advice experienced users here give me on the best way to handle it. Should she stop Sema for a stretch before beginning Tirz? Or simply swap it out when the next dose is due?

I did try to bring her down to .25 once a week, but she was clear that she wants to keep going, since she figured sides would show up based on what her friends told her.

Once we move to Tirz, we'll stay with it - insurance or not, because gray market keeps it within reach, unlike the $750 a month coupon our pharmacy offers when insurance won't pay. From the start I told her that in my view Zepbound or Mounjaro would be the next step, and I expected our doctor would put her on one of them based on the research I'd done. After yesterday, he confirmed that. Having our doctor supervise her on it would be a good thing. And he will, even through gray market. That said, he'll push us toward Ro or another compounding pharmacy that meets fda standards rather than my China buys. He's already aware that I use peptides - a couple of years ago he even helped me find TB and BPC through a source he trusted, unofficially, which is how my peptide journey got started.



More research needed….
 
Unless your insurance is genuinely good, the first thing they'll push is the cheapest glp1, if they'll pay for any of it. Most likely oral semaglutide
 
Switching straight to tirz should be fine — the sema amount isn't large, 0.25 twice a week, and that amount already brings side effects. Tirz usually comes with less nausea than sema, and beginning tirz at 2.5mg/week is very unlikely to cause worse side effects than 0.5 of sema. It's probably wise to hold off until any nausea from the latest sema dose has calmed down, maybe 4-6 days after the last sema dose to be cautious.

In my case, even tiny sema amounts at 0.22mg every 2 days gave me far worse nausea than 15mg/week of tirz.

On insurance vs grey, it's much harder to say — at least with grey, nobody else controls the medication. And folks in the US have frequently complained about insurance companies changing their rules and cancelling their GLP medication.
 
lessthanhalf said:

Switching straight to tirz should be fine — the sema amount isn't large, 0.25 twice a week, and that amount already brings side effects. Tirz usually comes with less nausea than sema, and beginning tirz at 2.5mg/week is very unlikely to cause worse side effects than 0.5 of sema. It's probably wise to hold off until any nausea from the latest sema dose has calmed down, maybe 4-6 days after the last sema dose to be cautious.

In my case, even tiny sema amounts at 0.22mg every 2 days gave me far worse nausea than 15mg/week of tirz.

On insurance vs grey, it's much harder to say — at least with grey, nobody else controls the medication. And folks in the US have frequently complained about insurance companies changing their rules and cancelling their GLP medication.
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I appreciate you detailing how the two medications compared for you. At this low Semaglutide dose my wife can barely bring herself to eat because of nausea, so I'm leaning toward making the switch next week — I've already placed an order for 2 vials of Tirz, arriving Wednesday next week. Your point about letting the Sema-induced nausea clear first, so that adding another variable doesn't muddy which side effects come from where, makes a lot of sense to me.

Did Tirz give you any side effects?

As for gray versus insurance, we'll keep Tirz on hand in case insurance won't cover it, or if coverage gets dropped at some point down the road.
 
woundcarping said:

I'd give sema a miss and go with grey tirz, though that could muddy the insurance picture. My insurer probably won't cover tirz for someone who's only pre-diabetic.
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I'm with you — getting insurance to pay when the only diagnosis is pre-diabetes probably won't happen.

My own attempt at coverage for Zepbound happened while I was pre-diabetic, carried a BMI of 42, had sleep apnea, and my cholesterol was borderline high. Denial followed denial, and I even went through a medical appeal. The lesson I took away: once a plan excludes a medication, being sicker makes no difference — there's simply no coverage.

The advice to switch to grey tirz is sound as well.
 
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