When originally launched, these medications were available to a wide range of patients. Insurance companies are now limiting how we can prescribe these medications and, as a result, we have experienced a huge influx of prior authorizations for patients that do not meet the indications of the medication.
Ozempic, Mounjaro, Trulicity, Victoza, Bydureon and Rybelsus are ONLY FDA approved for patients with Type 2 Diabetes.
• If you are prescribed a GLP-1-1RA and are not a Type 2 Diabetic, your insurance carrier will not cover it. If a prior authorization is required, we will NOT be able to complete this without a diagnosis of Type 2 Diabetes.
• We have not been successful in getting this class of drugs approved with the prior authorization.
Many carriers will tell patients that these medications are on their formularies, but they are excluded if you are not a Type 2 Diabetic. This results in multiple prior authorizations for different drugs in this class. This process can take up to and beyond thirty days from the time the medication is prescribed.
What happens when a popular GLP-1RA or GLP-1RA/GIP is prescribed to me?
• Medications such as Ozempic, Mounjaro, and Trulicity are on a national backorder and can be difficult to locate.
The owners of Texas Diabetes & Endocrinology have thoroughly reviewed the situation and would like to provide you our position on GLP-1RA AND GLP-1RA/GIP medications.
• Texas Diabetes will only prescribe GLP-1RA (Ozempic/Trulicity/Rybelsus) or GLP-1RA/GIP (Mounjaro) medications for those patients that have a diagnosis of Type 2 Diabetes.
• Texas Diabetes may prescribe a GLP-1 OR GLP-1RA/GIP medication for weight loss if a patient meets FDA approved criteria. These medications are Zepbound, Saxenda, and Wegovy. Many formularies exclude these medications for weight loss as it is not a covered benefit.
Our prior authorization team will only process authorizations if you have a diagnosis that fits the criteria to ensure those patients who have an urgent medical need receive their medication in a timely manner. If the original medication that is prescribed is denied, we suggest that the patient contact their insurance carrier to find out which medication is on their formulary. Once we have that information, we will process a second prior authorization on your behalf.
