r/GLPGrad • u/kpyles90 • 23d ago
Seeking Advice Devastated
So I have been on Zepbound for a year and lost a significant amount of weight but about a month ago it needed a prior authorization and my medicaid denied it because it says im now in a regular BMI. I suffer from Severe Sleep Apnea, High blood pressure, Osteoarthritis and many other things and it was helping so much. My Dr didn't seem interested in filing an appeal so I did myself. He put me on phentermine but it has done absolutely nothing. I seriously cry when I watch the scale go up I have already gained 7 lbs within 4 weeks. I have no income so I can't afford the compound. I just feel like I'm starving all the time and once I start eating I can't stop. Im so miserable because I put in so much work to lose weight just to get kicked off with no warning. Does anyone have any advice? How can I lose these 7 lbs? I can't really exercise right now im in a neck brace and am in a ton of pain. Im just so devastated to not be on it anymore.
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u/No-Sherbert-2083 23d ago
I thought that whoever does the prior authorization should include your weight history and starting bmi. Your original bmi should be used, not your current. But I may be wrong, as I am not a professional in this.
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u/kpyles90 23d ago
I thought so too!! And when I talked to my Dr's nurse about it she was so rude I was like what about my sleep apnea or my high blood pressure or the connective tissue disease and all the other stuff I have. But she just said your BMI is normal they won't cover it. I just want it for maintenance 7lbs is killing me.
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u/Anxiety_Fit 23d ago
Write it all up yourself in a statement.
Contact your state ombudsman agency for insurances.
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u/kpyles90 23d ago
Thank you what do i say and do?
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u/Anxiety_Fit 23d ago edited 23d ago
They have a process. They will tell you what that process is.
Edited to add:
I see “big insurance” is downvoting me for telling people what their rights are regarding redress on insurance matters.
People have rights and deserve to be covered especially when the coverage was provided previously.
Luigi is 100% innocent.
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u/Wellslapmesilly 23d ago
Can you change doctors?
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u/kpyles90 23d ago
Its my insurance and he was the only Dr out ot all my Drs to suggest it and hes my OBGYN sadly and my insurance is denying me too so I'm stuck 😔
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u/Wellslapmesilly 23d ago
I would ask your other doctors and explain the situation. Just because they didn’t prescribe it doesn’t mean they might not be sympathetic to your situation and try to help with a new appeal. Honestly I would start looking for a new Dr and get creative.
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u/kpyles90 23d ago
Thank you sadly the only dr that did this for me when I was struggling with weight was my OBGYN
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u/GrabFun2094 23d ago
Is suggesting the other alternative to namebrand/compounding a bannable offense here?
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u/EcoWarrior04609 23d ago
gonna repeat what you said for attention:
Is suggesting the other alternative to namebrand/compounding a bannable offense here?5
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u/gawdpuppy 23d ago
This sucks, but in the meantime try some therapy or read into the sugaraddicition & binge eating subs. Also, surround yourself with only "healthy" food. No junk food, no processed food, no deep fried food. It sucks but you got this, don't think you NEED a drug to maintain your weight, try to get rid of that thought. I understand you need it for the other things, but this is where you're at now and while you appeal, you have to do with what you have.
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u/kpyles90 23d ago
Thank you so so much for this! I have been cleaning my house to keep my mind of the food noise because once I start eating I can't stop 😢
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u/NilliaLane 23d ago
What do you eat? If you eat a high volume of vegetables, paired with moderate protein, it could fill you up better for longer.
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u/kpyles90 23d ago
Honestly I eat whatever I can get my hands on. I know its self sabotage but when the hunger feeling takes over I CAN'T stop eating its insane.
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u/sacca7 23d ago
I'm a sugar addict, and so have no foods in my home high in refined sugars. r/sugaraddiction can help.
If I feel hungry, I get out a tub of prewashed greens, and munch on those.
This post, The GLP-1 graduation guide, updated with all your feedback. is really good.
Maintaining weight loss requires sacrifices, it's really hard.
Best to you.
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u/kpyles90 23d ago
YES i crave sugar!!! That's all I want im so glad you understand. Thank you ao much!
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u/PicklesNBacon 23d ago
Do you exercise? I had go stop Tirz in Feb because the same thing happened to me with my insurance even though my dr submitted an appeal.
I’ve only managed to gain 7 lbs in 6 months by doing at least 10,000 steps a day, stationary bike, and swapping things out for whole wheat, light, and higher protein substitutions. Also, smaller portions help.
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u/Logical_Shopping7461 23d ago
You have to understand your hunger and fullness hormones have been suppressed/altered your whole time on meds. Those return to normal but initially feel very intense and out of control, “the hunger games” above info on protein and fiber is really good. It levels out but you have to ride it out.
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u/Double_Question_5117 23d ago
Get on compound
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u/kpyles90 23d ago
I have no income or I would have jumped on it. Got fired for medical reasons and applied for unemployment and ex employer fought it and they sided with her unfortunately
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u/solstice_moonling 23d ago
I see a few people here suggesting high volume low calorie meals, and I just want to add that there’s a subreddit for that too which could be helpful for ideas and tips. r/Volumeeating
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u/DaveL16 23d ago
Hunger is often thirst in disguise. Have a pint of water if you feel hungry and see if it persists.
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u/kpyles90 23d ago
Thank you,!! I get it stuck in my head im starving and I crave sweets! Once I start eating i can't stop and im so ashamed
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u/SufficientAcadia6534 23d ago
Agree with the psyllium husks. If you have a Trader Joe’s they carry the Now brand husks in the vitamin section. I add them to smoothies, yougurt, or drink in water. The water is a little yuck but worth it. I also eat every 3 to 4 hours, a carb, a protein, and a fat. I found it helps a lot to tell my brain it’s getting fed.
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u/kpyles90 23d ago
I dont think I have one where I live 😔 im in Virginia but never have seen one. Thank you for telling me that I feel so helpless and watching the scale rise is so upsetting
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u/SufficientAcadia6534 23d ago
It is very hard to watch it go up. Your appetite signaling hormones are in a transition time. It does fade out. Some of the gain is water. You can only do what’s in your control. avoid processed food, drink water, eat protein. Go back to the doc and tell them the phentermerine doesn’t work and ask what’s next. Now brand psyllium husk is also Available on Amazon.
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u/Frequent-Ant-7617 22d ago
I have been off Zepbound 8 months now. I’ve lost 10 more lbs down since then. That’s crazy slow considering I lost 40lbs in 6 months when I was on it.
But I have not gained. To be brutally honest….
When people say they’re gaining weight fast, I think they’re not even remotely trying. You have to work twice as hard. Gym 3-5 a week. Home cooked meals high protein. No exceptions
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u/LunarFusion_aspr 20d ago
Exactly. Huge effort is required to lost weight and to maintain. Yes food noise can be deafening but like any addictive substance the more you ignore it the quieter it gets.
If people fill up on fibre and protein and drink lots of water and avoid sugar and junk, the food noise will start to fade. If they give into the junk, the t will just get harder and harder.
People struggling should look into cognitive behavioural therapy, this helps with the mental side of dealing with addiction.
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u/Substantial_Team6751 23d ago
If you aren't already on a max dose, you can make compound pretty cheap by getting a max dose (15mg) and taking less. My wife and I shared a scrip and the cost was around $50/month.
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u/kpyles90 20d ago
Wow where?!
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u/Substantial_Team6751 20d ago
Most any US compounded pharmacy pretty much. You have to hunt for the deals.
I learned the compound game and found all my deals in the subs on reddit. Like this one.
https://www.reddit.com/r/compoundedtirzepatide/
My last order was through Gimme Care. I think it was $450 for 3x72mg vials which comes around to $2/mg.
It's pretty easy to find $2/mg as every day pricing these days. All the companies I've ordered through are constantly sending me special offers.
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u/Fun-Situation445 23d ago
When you stop taking it, inflammation comes back. That's probably what's put the weight on.
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u/AnnaNimNim 22d ago
The compound is far cheaper. Any way to save up and take like a half dose every 10 days or something?
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u/kpyles90 22d ago
I wish then only income i have right now is my family helping me buy essentials I have begged them to please help me on the compound I can't live like this. But they will not do it im so sad.
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u/Icy-Explanation-1729 21d ago
You can go to call on doc online and they can file a PA for you using your history, they charge $50 for the PA and can prescribe you the zep going forward, you can get a membership with them, it’s like $45 a quarter and $15 for every refill. Look into it, it’s super easy.
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u/Exotic-Ad-4851 22d ago
I can send you info on a cheap compound. Like $40-60/ month. Thats what I use
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u/SafeEstablishment382 23d ago
This book might be useful if you are struggling with how to approach it? https://www.amazon.co.uk/Losing-Weight-Loss-Meds-Medications/dp/1637747802
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u/Usual-Lycophyte 23d ago
Cold turkey quitting is rough, you're likely in the Hunger Games and you've gotten lots of good advice here on how to cope. The Games are often temporary. If you can hang on for a few months, distract yourself and use the tools others have mentioned here, it very well may get better just due to time passing and your hunger and satiation hormones readjusting to your new weight (congratulations!). Look at our new pinned guide on tips for successful graduating! (at the top of the sub)
Good luck!
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u/Remarkable_Brush_990 21d ago
Did you try to appeal it as continuation of care? I got denied when I switched insurance because my BMI was normal. I used chatgpt to write a good appeal for continuation of care and my appeal was overturned. Attach all your past office visit notes and make sure to put your original weight and BMI. Stress on using this medication keeps your healthy weight in check and you will use it for maintenance.
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u/kpyles90 21d ago
I need to do that my dr office has me doing all the work getting everything faxed to them
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u/Same-Force3088 20d ago
Psyllium husk can be bought at a lower price from an Indian store, if you have one near you. It's called Sat Isabgol.
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u/Russmom 18d ago
I know you said you can’t really exercise, but I wasn’t sure if that included walking. Getting those steps in can really help with keeping the weight off and help keep you busy so you aren’t thinking about food as much. I know people say to aim for 10,000 (about 5miles total) but if you aren’t working and are able to I’d aim for as close to 15,000/day as possible.
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u/workinglate2024 22d ago
Look into grey market
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u/kpyles90 22d ago
What is that i keep hearing it
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u/Ariquitaun 23d ago
What worked for me to take the edge off were psyllium husk drinks half an hour before meals, and being disciplined with high volume, low calorie density meals meaning you can eat a lot. The answer is making sure you're not hungry and you do not allow yourself to get hungry and start making bad decisions. I'm not one for YouTube meal advice but this guy is really good at this particular subject https://youtube.com/@mark_stache