I Lost Access to My GLP-1 Weight Loss Drug. What Now?

Sydney Anderson had no warning that her insurer would cancel coverage for her GLP-1 weight loss drug. The 28-year-old had lost 70 pounds using tirzepatide and was still overweight when her insurer suddenly denied coverage to anyone without class 3 obesity.

“I had to stop cold turkey,” says Anderson, who lives in Lynchburg, Virginia.

“I feel helpless,” says Anderson. “I finally found something that was helping my health, and my ability to obtain it was taken away.”

There are no easy answers for people like Anderson who have lost their GLP-1 drug access and are struggling to keep off the weight. Some have been able to find discounts or extend their coverage, or they have received approval for bariatric surgery. Others have been forced to consider alternative medications, including untested compounded drugs and older, less effective weight loss drugs.

Some GLP-1 users have been able to win back coverage by pursuing every possible option in the confusing world of healthcare.

Appeal Lost Coverage

Bridget Roberts, 37, was reapproved for Zepbound by remaining patient and persistent. It started when the Pottsgrove, Pennsylvania, resident received a letter that her insurance company was no longer covering the GLP-1.

“Initially, I felt I was doomed,” she says. “Something was finally working for me, and I was more alive than ever, and they wanted to take it from me.”

Switch Diagnoses

Other GLP-1 users have successfully retained coverage by changing the diagnosis indicated on their prescriptions.

“Many GLP-1s are FDA approved for more than just weight loss, including type 2 diabetes, cardiovascular risk reduction, and even stroke prevention in certain populations,” says Supriya Rao, MD, a gastroenterologist and obesity expert at Integrated Gastroenterology Consultants in Boston.

If your insurer canceled coverage for a weight loss medication, it is possible that it will cover the same medication for a different condition, such as sleep apnea or heart disease. A new prescription for a new condition “can make the difference between full denial and full coverage,” says Dr. Rao.

Brianna Johnson-Rabbett, MD, an endocrinologist with Nebraska Medicine and a director of the American Board of Obesity Medicine, offers some examples. “If someone has established cardiovascular disease and obesity or overweight, Wegovy can be prescribed under that indication,” Dr. Johnson-Rabbett says. “If someone has moderate to severe obstructive sleep apnea and obesity, Zepbound can be prescribed for that indication.”

Switching diagnoses is no guarantee of coverage, however. “Insurance still may decide not to cover a medication, even if FDA indications for prescribing that medication are met,” says Johnson-Rabbett.

Search for Discounts

A variety of discounts may be available from the manufacturers.

The makers of Wegovy and Zepbound offer coupons and savings cards that can considerably lower your out-of-pocket cost for as long as one year. Not everyone qualifies for these programs, however, and they cannot be used indefinitely.

Although compounded GLP-1 drugs are less expensive than their brand-name counterparts, their cost can still be considerable. Wyatt initially thought she would not be able to afford compounded semaglutide. She eventually found a provider offering a price she could pay but only after taking an additional part-time job. In the meantime, she had missed so many doses that she had to start back with the lowest possible dosage, delaying her progress.

“As of now, the compounded GLP-1 medications are still possible to obtain,” says Brynna Connor, MD, a family medicine physician in private practice in Austin, Texas. Compounders can sell GLP-1 drugs only in a novel dosage or formulation. As a result, some online pharmacies are marketing semaglutide and tirzepatide that have been combined with other medications or that take a significantly different form, such as a pill. These new drug forms have not been publicly tested for safety or how well they work, which can only magnify the concerns held by public health authorities.

“These aren’t well studied, and I advise against them,” says Rao. “Compounded versions in pill form or mixed with other ingredients haven’t undergone rigorous trials. Mixing active compounds without clinical data raises concerns about absorption, bioavailability, and patient safety. Just because it’s cheaper doesn’t mean it’s better or safe. If it sounds too good to be true, it probably is.”

Some people who know they’re about to lose access to their GLP-1 medications try tapering or microdosing to stretch out their supply and delay weight regain for as long as possible.

Microdosing involves using an injection pen to deliver smaller doses than those indicated on a prescription. The practice is easiest with Ozempic, which comes in a multidose pen, or with the glass vials that can be purchased directly from the drug manufacturers. Microdosing can be used to gradually taper a dosage down to zero, stretching out your supply rather than ending your usage abruptly.

Rao says, “It’s never a good idea to stop cold turkey,” and it is critical to consult with your doctor before adjusting your doses.

Microdosing can also introduce new hazards, according to Johnson-Rabbett, including “contamination and unintended dosing, for example, taking a much higher dose than intended,” she says, adding that another way to stretch your supply is by taking injections less often than every seven days, but this can be difficult to tolerate. “Depending on the person, the dose, and the duration between doses, that practice can result in an individual having side effects when they do take their next dose,” she says.

Although stretching out your supply and tapering your doses under a doctor’s supervision may smooth the transition away from a GLP-1 weight loss drug, it’s not a permanent solution.

Long before Ozempic became a blockbuster, the FDA approved a variety of other medications to help people slim down.

• Liraglutide (Saxenda), a less powerful older GLP-1 drug, “works well for appetite suppression,” says Rao.
• Orlistat (Xenical, Alli) reduces fat absorption in the gut and is the only effective over-the-counter weight loss pill available, says Johnson-Rabbett, though it can have significant gastrointestinal side effects.
• Naltrexone-bupropion (Contrave) combines an opioid blocker with an antidepressant to help control appetite and “may work better for emotional or reward-based eating,” says Rao.
• Phentermine (Lomaira) is a stimulant that suppresses appetite.
• Phentermine-topiramate (Qsymia) combines phentermine with an anti-seizure medication to promote weight loss and “is on average the most effective oral medication,” says Johnson-Rabbett.

Rao says that some doctors may also consider prescribing the type 2 diabetes drug metformin. This daily pill helps with insulin resistance, is sometimes used to treat prediabetes off-label, and leads to modest weight loss.

None of these drugs work as well as semaglutide or tirzepatide, experts say, but they may help with weight loss maintenance.

Anderson, who had to quit Zepbound cold turkey, was prescribed phentermine to help keep off the weight, but she has been disappointed with the results. She has regained 20 pounds, and her polycystic ovarian syndrome symptoms, which had disappeared with weight loss, are returning.

Weight loss surgery is the GLP-1 alternative that offers the most promise for sustained success. It is possibly an even more powerful weight loss therapy than GLP-1 medications, especially for people who still have a lot of weight to lose.

Rao says, “This will be very individualized. For patients with a body mass index over 40 (or 35 with comorbidities), bariatric surgery is safe and effective. Some patients may respond better to surgery than medication, especially if they have struggled with severe obesity for years and also have metabolic complications. Surgery is a valid, proactive tool that can save lives.”

“It can certainly be a good option to consider for an individual if they meet criteria,” says Johnson-Rabbett.

Many people try to maintain weight loss the old-fashioned way, by following a healthy diet and exercising regularly, which are important to practice while on a GLP-1, too.

While a quality diet and exercise are pillars of any healthy lifestyle, with effects on health measures besides weight, they have historically fallen short of treating obesity. “For many,” says Rao, “lifestyle changes aren’t enough.”

A new wave of supplements, each claiming to be nature’s Ozempic, sprung up during the initial GLP-1 craze. Despite the aggressive marketing, there are no “randomized clinical trials that show over-the-counter supplements have a substantial effect on lasting weight loss,” Connor says.

Be wary of claims that ingredients like berberine and psyllium husk can mimic or replace the effects of a powerful drug like semaglutide or tirzepatide. “There are no supplements, magic pills, or over-the-counter products that will reduce appetite and slow gastric emptying the way GLP-1s do. Don’t fall for anything that says otherwise,” Rao says.

These substances probably don’t work, and they might not even be safe: “Many physicians have concerns about the minimal regulations that supplements are subject to and have concerns about potential contamination of supplements, in particular supplements marketed for weight loss, with unsafe substances,” Johnson-Rabbett says.

The Takeaway

• People are losing access to the GLP-1 weight loss drugs semaglutide and tirzepatide due to insurer coverage changes and FDA actions against compounding pharmacies.
• To regain or maintain access, some patients are appealing denials by insurers, switching diagnoses, and finding manufacturer discounts.
• Alternatives include using compounded GLP-1s despite safety concerns, tapering or microdosing the existing medication under medical guidance, trying older weight loss drugs, pursuing weight loss surgery, or relying on diet and exercise.
• Working with a healthcare provider is crucial when managing weight and maintaining weight loss, as obesity is a chronic disease that deserves professional treatment.