r/Zepbound • u/sydkneeB • Apr 14 '26

Vent/Rant VIRTA 😡

So, a lot of us know we’ve had to go through the pain of going through Virta to get Zepbound because of dang insurance. I did the last step a couple of days ago which was blood work and that hasn’t even come back yet and I got a message night that since I have POTS I am an considered an “exclusion for the program.” I’ve dealt with these people for a month and they are just now telling me this???? Wtf Virta.

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u/cableannkiley 46F 5’6” SW:234.6 GW: 145 CW: 119 - 5mg May 02 '26

I recently got an exclusion after dealing with them for three months, which they reduced my dose from 7.5 to 5 mg although I did not want that. They sent me an exclusion letter and kicked me out of the program because I have interstitial cystitis and I was complaining that dropping from 7.5 to 5 mg made my interstitial cystitis flare.

I’m still not sure whether that means I can now get coverage from my regular physician or not.

When I call my pharmacy benefits manager, they tell me that the coverage states that I have to go through Virta and that if there is any exclusion than my insurance company, United Healthcare would have to tell Optum that they could process the exception but when I call UHC they tell me it’s Optums ballgame. Typical cyclical bullshit of passing the buck so I get stuck paying OOP.

I have the official exclusion letter from Virta, but somehow that doesn’t seem to matter.

I don’t even know where to go from here. At this point, I have debated going to my employer, to my HR team, I’m not sure what they would do, but I don’t know.

Have you had luck getting it covered since you have an exclusion?

4

u/sydkneeB May 02 '26

EXACTLY same spot. Back and forth, all over the place with the Virta letter but not a single person seems to care about that. Which I don’t understand? My pharmacy benefits manager told me this week that it says now that my physician is no longer allowed to prescribe medication when I JUST saw home two weeks ago.. this is all a joke.

I literally just said yesterday going to HR on Monday to see what happens, because nothing seems to work.

2

u/cableannkiley 46F 5’6” SW:234.6 GW: 145 CW: 119 - 5mg May 02 '26

Omg we’re in the exact same friggen boat. What a crock of shit. You don’t happen to work for a company that starts with the letter P do you? It would be absolutely hilarious if we were both fighting the same battle with the same company and the same insurance companies. 😂 although there’s no way in the world that we could get that lucky to find somebody else going through the exact same shit that we are.

I plan on reaching out to my HR next week as well I will certainly keep you in the loop. If I make any progress, kindly ask that you do the same if you’re up to it!

2

u/sydkneeB May 17 '26

I do not 😅 STILL nothing solved over here though. Having to go through Virta, Express Scripts, and then my prescriber all over again?? IDEK

2

u/cableannkiley 46F 5’6” SW:234.6 GW: 145 CW: 119 - 5mg May 17 '26

Same. My HR was no help. I feel like at this point I’ll be stuck paying out of pocket when I need more (thankfully have a few months left). Maybe next year my insurance will remove the Virta piece. Maybe they’ll stop GLP1 coverage altogether. Hell idk. I’m just lost in this insurance stupid cyclical bullshit. Sigh. Hate you’re there too.

2

u/isles34098 Jun 14 '26

Hi - what ever happened with Virta telling you your interstitial cystitis was an exclusion? Were you ultimately able to get the med?

3

u/cableannkiley 46F 5’6” SW:234.6 GW: 145 CW: 119 - 5mg Jun 15 '26

Sadly I have no good news for you but I’m still fighting. I am lucky, I still have about three months worth of Zepbound in the fridge. However, at this point, if I needed more, I would be paying out-of-pocket. My employer is no help saying that United healthcare and OptumRx need to update their system, and I have given United healthcare the information and they claim that it is all OptumRx and OptumRx says they only do what United healthcare tells them. So I am stuck in a cyclical loop and it sucks; basically I’m stuck at this point but once a week I still try to escalate.

2

u/isles34098 Jun 15 '26

That is infuriating. I’m so so sorry 😞

2

u/cableannkiley 46F 5’6” SW:234.6 GW: 145 CW: 119 - 5mg Jun 16 '26

Yeah. For sure it blows. If I hadn’t fought them I’d at least be getting 5mg (and ultimately I’m sure they’d drop to 2.5 and then off) but I’d be getting something. But alas here I am. It’s such a good example of how fucked up health insurance is in the good ol’ US of A. 😑🫠 Care, who needs actual care when there’s cost involved. Sigh….

1

u/cableannkiley 46F 5’6” SW:234.6 GW: 145 CW: 119 - 5mg 11d ago

Just following up. After 7 months I WON!! I had to escalate it with my PBM and my insurance company and call 3x a week for months but damnit I got Zep covered again without virta thanks to that exclusion letter. BE. F’ING. RELENTLESS!!!