Ozempic and insurance coverage

Type 1 for 36 year, started with strong insulin resistance in the last 5 year.

Which insurances have you all managed to get Ozempic covered for type 1.

I had no issues with BlueCross Blue Shield in 2021. Fought for it with Cigna in 2022 but now they are refusing to cover.

Ozempic is not FDA approved for Type 1 diabetes. The reasoning is concerns around low blood sugar. However, the exact same drug, Wegovy, in higher doses is approved for Type 1. The effects of the drug are dose dependent so this makes little sense. Ozempic works on 3 pathways - 1) it slows gastric emptying so sugar enters the bloodstream more slowly, 2) it increases overall insulin production, and 3) reduces hepatic glucose. While i understand the drug will do nothing for us as far as insulin production the other two items are huge. The major impact for me has been the liver glucose.

Do we know what the JDRF is doing to sway the FDA to approve Ozempic? While I have not gotten any weight loss benefits it has helped reduce my overall blood and improved my insulin resistance. I am actually quite concerned with stopping the medication.

Well, while I have no idea about who would cover it, but insulin is by prescription. Some things in the drug may be far too dangerous for type 1, there’s nothing you or anyone else can do to fight FDA approval or disapproval, which makes a lot of sense because it would have to go through years and possibly decades of testing and trials before approval, with that being said, “same chemical compound” doesn’t mean same drug. I am on lantis and my insurance stopped covering it recently, we found out that there’s a drug made with the exact same ingredients. We called my endo and found out that the medicine we wanted was actually the least recommended that they cover. Most of the time “off-label” or “generic” doesn’t exactly mean same so they couldn’t use that testing either, in other words give it time for either approval or disapproval, either way, you would want to switch to a different insulin that is covered and FDA approved, good luck and happy hunting

Update: After researching further, the side effects may be pretty bad, including but not limited to cancer, pancreatitis, etc… while I get not wanting to change insulins, sometimes throughout your time as a type one, you may just have to switch, see what works and all

I am on lantis and my insurance stopped covering it recently…

Hi @REESEScups07
To hopefully clarify while Ozempic is an injectable used to treat diabetes, it is not insulin.
When insurances decide to stop covering certain formulations of insulin (or presumably other meds), it may be possible to get an exception or override if your doctor can prove medical necessity: from time to time the patient is allergic to the new preferred formulary, or has found it simply does in not work for them. My doctor has done this a couple of times when the one my insurance was switching to was not approved for pumps🤪, but without a qualifying reason you’ll likely have to switch. That said, I have had to “go with the flow” on other occasions and thankfully the new medication worked just as well. I hope things work out for you.