Qsymia...anyone?

AnnPT77

kshama2001 wrote: »

chris_in_cal wrote: »

It's 2024 and my doc just prescribed Qsymia. My healthcare provider says a patient needs to fail on these older and less expensive (and less effective) drugs, before considering Zepbound or Wegovy.

When my doctor told me I needed to take a drug I didn't want before he would prescribe the drug I did want, I accepted the prescription for the drug I didn't want, googled its side effects, and reported the ones that seemed reasonable for me to report. After a few months, I did get the drug I wanted. Which, BTW, was one I had taken while with a different insurance company. I had no side effects with my desired drug - the one I didn't want to take had a long list of side effects. My desired drug was not in the new company's formulary, hence the hoops.

I suspect your hoops are actually due to the nationwide shortage of semaglutides. I can't imagine a doctor saying, "Sure, the FDA has approved a new anti-depressant, but you have to fail on all the old anti-depressants before I will prescribe it."

My insurance company has done this with other drugs for a different condition - I needed to fail on the less expensive, older one, before they'd spring for the newer and more expensive one. The side effect profile wasn't worse on the older drug, so I was fine with this in my case (not saying Chris should be fine with it in his case, not my call). Not sure how I would've felt if the old one was reported to have worse side effects.

Honestly, this (as described in my case, not Chris's) is exactly what I'd choose to do if it were my money at stake rather than the insurance company's; If a cheaper, better understood drug works, that's a win, to me.

Again, underscoring: I'm not saying I think this is how Chris should feel. I'm commenting because my insurance company effectively did say "Sure, the FDA has approved a new drug for this condition, but you have to fail on the old drugs before we'll pay for it."

sollyn23l2

kshama2001 wrote: »

chris_in_cal wrote: »

It's 2024 and my doc just prescribed Qsymia. My healthcare provider says a patient needs to fail on these older and less expensive (and less effective) drugs, before considering Zepbound or Wegovy.

When my doctor told me I needed to take a drug I didn't want before he would prescribe the drug I did want, I accepted the prescription for the drug I didn't want, googled its side effects, and reported the ones that seemed reasonable for me to report. After a few months, I did get the drug I wanted. Which, BTW, was one I had taken while with a different insurance company. I had no side effects with my desired drug - the one I didn't want to take had a long list of side effects. My desired drug was not in the new company's formulary, hence the hoops.

I suspect your hoops are actually due to the nationwide shortage of semaglutides. I can't imagine a doctor saying, "Sure, the FDA has approved a new anti-depressant, but you have to fail on all the old anti-depressants before I will prescribe it."

It's the insurance companies generally. They dictate what can and cannot be prescribed that they will cover. For example, I have osteoporosis. Before my insurance would cover med costs, they dictated that I first had to take calcium supplements for 2 years, demonstrate that that failed to correct my osteoporosis before they would cover any meds. Then I had to try the cheapest, least effective med for 2 years and fail on that before they would cover a more expensive, more effective med.

chris_in_cal

sollyn23l2 wrote: »

It's the insurance companies generally. They dictate what can and cannot be prescribed that they will cover. For example, I have osteoporosis. Before my insurance would cover med costs, they dictated that I first had to take calcium supplements for 2 years, demonstrate that that failed to correct my osteoporosis before they would cover any meds. Then I had to try the cheapest, least effective med for 2 years and fail on that before they would cover a more expensive, more effective med.

This sounds so broken, I'm sorry you have to go through it this way.

With Ozempic and obesity/diabetes it seems like a quantum leap, like the discovery of antibiotics in the 1930s. Imagine a patient with syphilis in 1946 having the doctor suggest a four year treatment with essential oils, and only if that doesn't work move on to penicillin.

I do not believe there are any broad based, safe, and widely effective medicines for treating people who are obese. Suddenly there are. Nobel prizes all around.

kshama2001

AnnPT77 wrote: »

kshama2001 wrote: »

chris_in_cal wrote: »

It's 2024 and my doc just prescribed Qsymia. My healthcare provider says a patient needs to fail on these older and less expensive (and less effective) drugs, before considering Zepbound or Wegovy.

When my doctor told me I needed to take a drug I didn't want before he would prescribe the drug I did want, I accepted the prescription for the drug I didn't want, googled its side effects, and reported the ones that seemed reasonable for me to report. After a few months, I did get the drug I wanted. Which, BTW, was one I had taken while with a different insurance company. I had no side effects with my desired drug - the one I didn't want to take had a long list of side effects. My desired drug was not in the new company's formulary, hence the hoops.

I suspect your hoops are actually due to the nationwide shortage of semaglutides. I can't imagine a doctor saying, "Sure, the FDA has approved a new anti-depressant, but you have to fail on all the old anti-depressants before I will prescribe it."

My insurance company has done this with other drugs for a different condition - I needed to fail on the less expensive, older one, before they'd spring for the newer and more expensive one. The side effect profile wasn't worse on the older drug, so I was fine with this in my case (not saying Chris should be fine with it in his case, not my call). Not sure how I would've felt if the old one was reported to have worse side effects.

Honestly, this (as described in my case, not Chris's) is exactly what I'd choose to do if it were my money at stake rather than the insurance company's; If a cheaper, better understood drug works, that's a win, to me.

Again, underscoring: I'm not saying I think this is how Chris should feel. I'm commenting because my insurance company effectively did say "Sure, the FDA has approved a new drug for this condition, but you have to fail on the old drugs before we'll pay for it."

@AnnPT77 Were your medications in the same class? Phentermine has a very different mechanism of action than semaglutides.

kshama2001

sollyn23l2 wrote: »

kshama2001 wrote: »

chris_in_cal wrote: »

It's 2024 and my doc just prescribed Qsymia. My healthcare provider says a patient needs to fail on these older and less expensive (and less effective) drugs, before considering Zepbound or Wegovy.

When my doctor told me I needed to take a drug I didn't want before he would prescribe the drug I did want, I accepted the prescription for the drug I didn't want, googled its side effects, and reported the ones that seemed reasonable for me to report. After a few months, I did get the drug I wanted. Which, BTW, was one I had taken while with a different insurance company. I had no side effects with my desired drug - the one I didn't want to take had a long list of side effects. My desired drug was not in the new company's formulary, hence the hoops.

I suspect your hoops are actually due to the nationwide shortage of semaglutides. I can't imagine a doctor saying, "Sure, the FDA has approved a new anti-depressant, but you have to fail on all the old anti-depressants before I will prescribe it."

It's the insurance companies generally. They dictate what can and cannot be prescribed that they will cover. For example, I have osteoporosis. Before my insurance would cover med costs, they dictated that I first had to take calcium supplements for 2 years, demonstrate that that failed to correct my osteoporosis before they would cover any meds. Then I had to try the cheapest, least effective med for 2 years and fail on that before they would cover a more expensive, more effective med.

UGH you all are starting to convince me.

However, I still think the shortage is relevant:

https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/medications-containing-semaglutide-marketed-type-2-diabetes-or-weight-loss

"...As of May 2023, Ozempic and Wegovy are both listed on FDA’s Drug Shortages list."

AnnPT77

kshama2001 wrote: »

AnnPT77 wrote: »

kshama2001 wrote: »

chris_in_cal wrote: »

It's 2024 and my doc just prescribed Qsymia. My healthcare provider says a patient needs to fail on these older and less expensive (and less effective) drugs, before considering Zepbound or Wegovy.

When my doctor told me I needed to take a drug I didn't want before he would prescribe the drug I did want, I accepted the prescription for the drug I didn't want, googled its side effects, and reported the ones that seemed reasonable for me to report. After a few months, I did get the drug I wanted. Which, BTW, was one I had taken while with a different insurance company. I had no side effects with my desired drug - the one I didn't want to take had a long list of side effects. My desired drug was not in the new company's formulary, hence the hoops.

I suspect your hoops are actually due to the nationwide shortage of semaglutides. I can't imagine a doctor saying, "Sure, the FDA has approved a new anti-depressant, but you have to fail on all the old anti-depressants before I will prescribe it."

My insurance company has done this with other drugs for a different condition - I needed to fail on the less expensive, older one, before they'd spring for the newer and more expensive one. The side effect profile wasn't worse on the older drug, so I was fine with this in my case (not saying Chris should be fine with it in his case, not my call). Not sure how I would've felt if the old one was reported to have worse side effects.

Honestly, this (as described in my case, not Chris's) is exactly what I'd choose to do if it were my money at stake rather than the insurance company's; If a cheaper, better understood drug works, that's a win, to me.

Again, underscoring: I'm not saying I think this is how Chris should feel. I'm commenting because my insurance company effectively did say "Sure, the FDA has approved a new drug for this condition, but you have to fail on the old drugs before we'll pay for it."

@AnnPT77 Were your medications in the same class? Phentermine has a very different mechanism of action than semaglutides.

No, not GLP-1 drugs, different diagnosis. But it's IMU a common thing with insurance companies to have a formulary where there are standard drugs they cover, and to want a person to try a less expensive drug (that has been found effective to some degree) before approving a more expensive one. IME, ditto for procedures: I've had to get certain less-expensive tests, see non-useful results from those, then they'd approve more expensive tests.

I've never experienced a case where they wanted me to try a drug that was considered ineffective before one that was considered effective (by the medical community), but I don't think that the drugs needed to have the same mechanism of action: The drugs just needed to have a track record of usefulness for some people for the same condition.