Zepbound VIALS are Released | My New PA was DENIED?! | Week 28 with KetosisMom

[Music] hey everybody and welcome back to my channel I'm Jen kosis mom today is my week 28 I cannot believe I'm on week 28 of Zep bound I'm going to be going over my week 27 results with all of you as well as showing you my week 28 injection which will be my very first injection of the 7.5 mgram I'm going to talk about my denial that I received that's right a denial for my recent PA that the insurance asked for I'm going to go over what happened throughout that entire process where it stands today we'll also talk about glp ones in the news like zet bound getting a price cut and those vials getting released so let's go ahead and get started today is going to be brought to you today by a merge as you all know this is a compounded tepati option I did look into them I am now partnered with them as of about two weeks ago they did give me the code ketosis mom50 or you can as always go to my link and you will get $50 off your first two shipments I myself have received one of their shipments before it is sitting upstairs in my garage my husband and I are going back and forth over whether or not moving to compound is going to be the best option for me after we had the mishap with Pas going on uh we're going to get into that in just a moment first we're going to start today out with glp ones in the news with [Music] Jen the biggest thing on everybody's radar right now is the fact that Eli Lily is finally utilizing their Lily direct that they had set up if you all go back to one of my very first videos I went over the process and my thoughts about the planning team at Eli Lily and was this shortage really just a strategy that they had to try to get everyone to rush and get in line to their Lily direct thinking that they would be able to get their medicine their Mound jaro their Zep bound straight to them from Lily direct faster than they would at otheres it seems that Eli Lily finally took the hint on that one and they are now direct to Consumer cutting out all of the middlemen if you do not have insurance so listen up Medicare patients and everyone else who's paying out of pocket because your insurance has not been covering it for you typically if you have insurance and they're just not covering it you can use the Lily savings card and the price was any anywhere between $500 and $550 now you do not have to run it through any type of insurance whatsoever you do not have to get any kind of prior authorization whatsoever you can go straight to Lily Direct's website there is instructions there and I will put those down below in this caption as well as right over here on the side you ask your physician to send your prescription there and this is a cash option they are charging $399 for the 2.5 MGR vials and 549 for the 5 MGR vials now you can only get this in the United States per the fda's guidelines to Eli Lilly in both the 2.5 and a 5 mgram vials these are single dose vials meaning that they are not meant to be split up in any way shape or form and patients do not have to have knowledge on how much to draw out of each one of these vials you you should be removing everything within the vial into the syringe that they provide to you to inject into yourself now I will say I have touch based with multiple patients who were either on Medicare or paying out of pocket in full for this medicine and personally they all said I might pay that if it was a pill but I'm not really interested in going and having to inject myself with this they want the injector pins personally I feel like they really should be be offering these auto injector pens for a lot less um the vials cost them a whole lot more and the price that they are charging for this is fairly high if you look at a merge for instance who again is sponsoring today's video just so that you know if you look at a merge they go through three different pharmacies to get a compounded eptide however they're charging the same amount for regardless of which pharmacy it comes too rumor has it I don't know if aemerge will or not but a rumor has it that multiple of the Compounders are lowering their prices in response to Eli Lily coming out with this paid cash option so that their compounded version is nowhere near the 3.99 or the 5.49 price marks and is in fact much lower I have not seen that yet I can't wait to see if they do personally I am taking zet bound I have been taking zap Bound for 28 weeks I am hoping knock on W that I can at least finish the rest of this year out before all of the changes start coming into play I know probably at the end of December I will be having to make a decision based on comments like this that I'm seeing on forums you have a lot of people who work as benefit managers uh Insurance Brokers that are looking through all of the different insurance plans that are going to be available come 2025 it's not just Blue Cross Blue Shield anymore more that is cutting the coverage of all medical weight loss drugs not just Z bound not just o we GOI not OIC not M jaro but all weight loss medications and all weight loss programs are looking to be cut from the majority of our large insurance companies and the large three pbms that are controlling everything basically there's three large pbms that are controlling about 80% of the market they are also Under Fire with multiple States right now an example is Arkansas they are under litigation with four different players in their state and they have penalized them with millions of dollars owed to their local pharmacies it is in fact illegal for them to undercut the average National price to pay those pharmacies and they were in fact doing it so it's not going to take the FTC and the federal government going after these pbms and insurance companies anymore because now the states are doing it I will put a link down in the bottom there is an ongoing FTC investigation into pbms the house committee has also been meeting in regards to pbms finally sorry finally you even have in the news the noo nordis CEO going on record to say that the American pricing is in fact due to pbms and insurances and the way that they play ball here in the United States they do go on to say in this watch this week video I'm serious go watch it that in the UK they are charging 90 90ish dollars I think it was 92 $92 for OIC and around one in the UK and then $140 in ger Germany whereas in the United States it's over a thousand when they asked him to elaborate some more on this and explain why it was a very longwind in conversations about pbms speaking of OIC OIC has been working differently than what people thought there's now studies and articles talking about how people who are on OIC it is changing their metabolism and their metabolic structure their metabolism is speeding up these clinical findings are showing that these weight loss drugs are not just about eating less and moving more but it is a biological clinical diagnosis of obesity and some type of metabolic disorder that needs to be corrected within the body I would love to hear in the comments down below what you all are thinking about this new vials direct from Lily direct are you going to be signing up for this and trying to get either the 2.5 or the 5 milligram from Lily direct at 3.99 or 5.49 or are you not additionally if you had the choice or if you had to make the choice because it might be in my case pretty soon if you had to make the choice of paying $5.49 for the brand FTC FDA manufactured regulated drug versus a compounded tepati that's about $200 less which one would you choose would you choose to pay out of pocket about $200 more for the name brand federal regulated or would you go ahead and go with the compounded version from a pharmacy that is regulated by both their state as well as the FDA you guys tell me down in the comments below I don't want to be misleading in any way shape or form I am in fact taking Z bound I am still taking zap bound I've taken Z bound the entire time I am however working with a merge because I do understand that a lot of Americans have never had coverage for these drugs and they may never get coverage for these drugs also the pricing on these even the compounded versions I'm going to be honest with you guys I feel like everyone is overpriced when it comes to this when I saw when the Bernie Sanders team in the in them researching the actual manufactured version is only costing less than it was like $4.75 for a month supply and that's the manufactured version so you're looking at like even all the overhead cost associated with that and your employee cost and a full cost analysis I feel like if that is for legit regulated drug then these compounds are probably more like 25 and now what a lot of you have been waiting for I have been on this for 27 weeks this is now my 28th week and yes I have a PA denial there was a new PA request once I started trying to fill my 7.5 milligram I have no idea why other than it had been about 6 months since I first started the drug a lot of the insurances that I'm seeing are now requiring a new PA every 6 months on top of full documentation that you are working out your working with a nutritionist you are being checked by your doctor they're checking your lab work they're checking your weight you're on a scale that the PBM provides you which I think is a bunch of yeah lots lots of that um there's a lot of requirements being thrown out by different insurance companies mine I had not seen anything yet on any of the forums knock on wood I also had not received anything in the mail so when this new PA request came across I was a little confused I did reach out to my local endocrinologist office they sent something in where does it say it ah here it is and here is what CVS KARK wrote back to me your request was denied and they go on to say your plan only covers this drug when you experience benefits from taking the drug and when your results from taking the drug are sent to us your doctor needs to send us all of the following a your weight prior to starting the weight loss drug therapy B your weight now C the date your weights were taken we have denied your request because we did not receive all of your results we reviewed the information we had and your request has been denied your doctor can send us any new or missing information for us to review for this drug you may have to meet other criteria you can request the drug policy for more details you can also request other documents for your own review if you would like for us to send you a free copy of the guidelines the requirements the criteria or protocols we use to make this decision please call the number on the back of your prescription ID card so once I received that I wrote into my doctor's office and I said okay the first time you all sent in the PA you forgot to send in my medical diagnosis my medical chart was all of that sent yes it was they told me they sent when I started everything that went with that PA as well as everything from my past visit with my doctor if you all recall that was in June I had a full Lab blood workup that my internist had already done for her all the results were there as well as I was weighed in all of that was sent to CVS care Mark however they denied it so I got online with the Weight Watchers Clinic who saved me the first time in getting this approved for me to begin with I will tell you all that they insur coordinators are Barun the best they know exactly what to submit how to submit it in what order to submit it so that there's no questions asked the other thing that is so great about being a part of the Weight Watchers clinic and this is a plug no I am not affiliate of theirs as far as the clinic side goes you guys can get an affiliate link for just the normal weight watchers down below but I am not an affiliate of weight Watchers Clinic we've gone over that many times by the way they are the best because you are logging your food in there basically on a daily basis if you forget a day so what no big deal I have mine connected to my fitness watch so it automatically is logging my activity for them unless I'm not wearing my watch then I go in and I just manually log it in I'm also weighing myself constantly try to do it every every other day for them and I'm logging that into their system therefore they have all of this additional information to submit with their pa they have she's working with our nutritionist and dietician team she's working with our fitness instructor and here's all her Fitness activity she's logging her weight and we're looking at it and her clinician is looking at it to make decisions on whether or not her titration of this drug needs to change the titration of this drug needs to change because her weight has basically stayed the same for the past two months regardless of eating correctly having a fitness routine and being on the 5 milligram drug boom they submitted this and it was approved now I'm going to step back for just another second because there was another factor in here why was the PA even asked for to begin with my husband called called CVS care Mark and asked them this question amongst some other questions about billing issues with my centic because I have met my outof pocket minimum so everything for me is now a big fat goose egg we should not be paying anything for me for the rest of the year not what they had in there they had that we still needed to owe money on multiple of my medications which should not be the case they corrected all of this and then when my husband asked why the additional PA was requested here's the real kicker that you guys are going to love we were told that while I've been filling my prescription at a local pharmacy here in person and I've even been having my husband go pick it up for me and see all the other people standing around also there for the same drug Amazon Pharmacy had also been charging my insurance for the 5 mgram as well for the past last two fills this me and I never received it not sure who got it but it wasn't me so they filled my five they filled my 5 milligram last time when I picked it up locally and then when I picked up my 7 and 12 milligrams locally they also filled a 5 mgram filled it there and they charged the insurance and were paid yowzers so I had to contact Amazon Pharmacy and say hey you guys have been charging my insurance for medication that I never received they looked into this and saw that I in fact had never been shipped those items and they had to do a reversal of those charges yikes according to car Mark I should not have had to submit another PA until October 13th and I've already had to do another one because Amazon Pharmacy was already Auto charging these and then never shipping them which explains why I kept getting all the text messages and emails from Amazon Pharmacy reminding me that it was time to fill my prescription now I am recording this a little early because I would like to get the editing done I have a lot of contracts right now just sitting and I feel like nothing's getting done and I have some pretty large asks from some of my standing agreements that I have that are due within the next two weeks so I've been turning around in circles trying to mask produce and mask get things out as much as I can so I have this recorded now I'm not going to be taking my 7.5 milligram until in the morning when I do take that you're going to see a nice little video of it right over here I am starting on week 28 the 7.5 milligram the reason that I am moving up in the dosage is because my weight has really not changed much we're talking like maybe 2 lbs in the past two months each time I take my centic injection you all know I gain anywhere between 4 to 8ish pounds then my body is working to try to get that all off throughout about a 2 to 3 week period and then the last week of the month is usually my week to lose weight unless of course it's a cycle week or an off week or my body just decides to give up basically so the last two months for me have not been so great it's also time within the next few days for me to already be taking my centic injection again and I'm waiting for that to arrive right now so that I can try to even out the space between taking this zet bound injection and then taking the centic injection a few days later now I will also show you what my weight is tomorrow for what I lost during my week 27 so if if I did have a loss you will see that right here and then right down here I will put what my total weight lost is from February 14th until now so the full 28 weeks now I will tell you all the last few months for me have not been so Grand the best weight loss that I have had was at the 2.5 milligrams in the beginning I do need to get back into walking more I have been walking and I've been walking with my dog through the neighborhood but he's a French Bulldog he's not really doing a whole lot of walking halfway through I have to put him in a stroller and then we go the rest of the way because he his little legs just can't go anymore so I need to get back into the weight side of this and I will tell you all I have been sold this week on on this medication right here no I'm not working with them no I am not affiliated with them in any shape or form yes I will however put an Amazon link down below if you're interested in looking at it this is a mitop pure and there are a lot of different studies behind this and this ingredient as far as maintaining muscle and working with the mitochondria and the repair of mitochondria within your body now a lot of this is really more for like body Builders and weightlifters and things like that however for people who are on drugs like what we are taking muscle loss is big I did a whole video on maintaining your muscle bass throughout this process and if you can build muscle or at least maintain your muscle throughout this process then keeping the weight off long term is more in your favor the more muscle you have in your body the more it is processing glucose and processing sugar appropriately and the more it is supporting your body structure overall so I am taking this I started it about 2 days ago I'm still trialing it I'm not real positive on how it's going to go but I will keep you all updated on that as it goes along I will continue to watch the different pricings and put it over into our community tab I did place the article about Zep Bound in the pricing over there as well as where to have your doctor send the prescription if you are interested in having them pay out of pocket find that on my main page on YouTube under where it says Community I'm also going to put up one more time the emerge compounds for you all you can get $50 off your first two shipments so that's 25 off your first shipment and 25 off of your second if I am going to go into the compounding world come 2025 because all the insurances are changing then a merge will more than likely be what I will be using via Hallendale as long as they continue to not put anything other than the tepati the alcohol and the water into their mix of their compound I need to probably check back in with the merge doctors and nurses and make sure or even how Andale Pharmacy directly and their Pharmacy team to make sure that there are no other additives seeing as there's so many seasoned assist letters out there for the exact same formulation that is at Eli Lilly I do need to check in with them before I ever think about going into using that to ensure that they have not changed their formulation I do also know that quite a few people on here are using the Olympia that is a both a 503a and a 503b that feeds into the 503a the FDA has a lot of paperwork around Olympia as well and you can bulk byy from them they additionally have virtual providers that will provide you a prescription direct to them however you're looking at around ,000 for the total cost of this and you get about two months to plot um I will tell you all that one of the bonuses that I will give it to compound this is like a compound you know they get a a check mark and a win on this I do agree with a lot of the different doctors the functional medicine doctors that are online that micro doing and micro doing in your titration up may be a better approach for these drugs overall instead of going from like a 7.5 to a 10 or a f a five to a 7.5 to a 10 or a 10 to a 15 uh maybe if the five is not working for you then you go to a 5.5 and that is something that is possible with compounds and for someone like myself even I have a lot of side effects typically from drugs I do see a benefit to being able to control that dose a little more than the preset dosages that are coming out for manufacturing I also do know and I have noted in a lot of their studies that the majority of the true benefits that are coming from these drugs are at the higher dosages so in the sleep apnea study those were at a 10 and a 15 Mill dosage for those patients as well as the Alzheimer studies those are also at the 10 and 15 milligram dosages that's not to say that the lower dosages aren't going to have any effect on those type of things it's just the study was done at the higher dose of the drug so those are just some things to keep in mind as you're trying to navigate this whole wave that we're all on right now and the Ever Changing fluidity of it all so I want to thank everybody for tuning in today I appreciate you all subscribing as well as tapping that alert button that lets YouTube know that you are enjoying my material and that you would like to see more of it I love when you guys comment down below even ideas of things that you would like for me to cover or talk about in the future I try my best to answer everyone to the best of my ability the best of my ability just remember I am not a medical professional nor do I claim to be I've gone over my background many times in many different videos if you need to to go back and review that I come from a manufacturing background I do have a bachelor's and a master's degree in undergrad uh before I worked in both clinical and also pharmaceutical manufacturing you guys can support my channel in many different ways and I will list all of those down in the caption below you can find me over on Instagram at ketosis mom and also at Living Large and Lily you can shop with me on like to know it at Living Large and Lily and over on Amazon in my Amazon storefront at amazon.com forshop ketosis Mom thank you guys so much for tuning in and I'll see you guys next week bye y'all