Washington Man says insurance coverage is the “one challenge” about taking Wegovy for weight loss

Washington Man says insurance coverage is the “one challenge” about taking Wegovy for weight loss

Bill Carson Bill Carlson before and after taking Wegovy

Bill Carlson was overweight most of his life. Even after several attempts to lose weight on his own, he always ended up at his heaviest at 225 lbs., a “roller coaster ride of losing weight and gaining it back”.

The 39-year-old was unable to control his health until he was introduced to the anti-obesity drug, Wegovy, in late 2021.

Wegovy is an FDA-approved prescription medication — taken by injection into the thigh, abdomen, or arm — intended for people with chronic obesity. It is one of the brand names for semaglutide, which targets areas of the brain that regulate appetite.

Carlson – of Ellensburg, Washington – recently spoke to PEOPLE about the hurdles he had to overcome to get the obesity treatment drug, admitting that the hardest part of his Wegovy journey was “dealing with the health care system in the United States.” States”.

“Just getting insurance coverage and making sure I can stay on it and keep doing it is the only challenging thing about taking Wegovy,” he says. “My insurance company covers Wegovy for weight loss, but I still had to get pre-approval from them.”

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Washington Man says insurance coverage is the “only challenging thing” about taking Wegovy for weight loss, Bill Carlson

Bill Carson

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Carlson says his doctor recorded all of his vitals and health information and sent them to his insurance company. However, he was shocked to learn that despite meeting all the criteria, he was initially denied coverage.

He explains that although he has declared his height and weight, the insurance has denied coverage because he has not stated his body mass index, which is calculated using the two.

“I’m like, ‘I told you I weigh 225 pounds and I’m 5’8′”. You know my BMI is high.’ And so my doctor requested it again, but this time he explicitly stated the BMI, and then they accepted it,” Carlson said. “It took me about two months to get it all done.”

After pre-authorizing Wegovy, Carlson found that the out-of-pocket costs are quite expensive.

“With my insurance I do have a deductible on it,” he says. “So the first few months of the year it’s expensive. It’s $900. But after that it’s $25 a month. So on average it’s about $200 a month for me, taking into account my deductible.”

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man preparing Semaglutide Ozempic Injection checks blood sugar

man preparing Semaglutide Ozempic Injection checks blood sugar

Getty Man Preparing Semaglutide Ozempic Injection

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Determined to improve his health, Carlson – a senior lead software engineer at Microsoft – began using Wegovy in April 2022 regardless of cost. He admits that the pros easily outweigh the cons, and he saw a change almost immediately.

“I remember the very first day I took it – it was in the evening. The next day I got up and we had lunch, mac and cheese,” he recalls. “I normally eat half the box of it, but I took about five bites out of the mac and cheese and I felt a feeling I’ve never felt before, which is a sense of being full.”

“I always ate until I felt pain or, ‘We’re done eating. I think I’m going to stop eating.’ But it was such a different feeling and I’ve just never experienced it before,” he continues. “It blew my mind. So the first week I was re-learning how to eat, and it was insane.”

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The first two months, Carlson says he lost 2 pounds. every week before you “get into a good rhythm” of losing weight. He has lost a total of 55 pounds. so far.

During that time, his doctor wanted to closely monitor his blood work to make sure he wasn’t experiencing any serious side effects from the medication.

Ania Jastreboff MD, PhD., an obesity medicine scientist at Yale who doesn’t treat Carlson, told PEOPLE that the most common side effects of these drugs are nausea and diarrhea, and sometimes you may have vomiting or constipation.

“My doctor really wanted to make sure that all the side effects were addressed,” explains Carlson. “We checked my blood levels every month, kidney function, pancreas, thyroid, glucose monitoring, metabolic panels. We tried to keep track of that stuff really well. He knew some of the side effects, like nausea, so I also got a prescription for anti-nausea medication Zofran .”

Carlson, who first shared his story on Reddit, thankfully experienced only occasional nausea and abdominal pain from taking Wegovy, but says he had health problems before taking the obesity drug — high blood pressure, elevated triglyceride levels, sleep apnea, ocular migraines, etc. – were worse to manage.

“It’s hard to put into words how awful the side effects of obesity are – you’re tired all the time, when you go up and down stairs you get breathless, you go about your day huffing and puffing, your just feel nauseous all the time,” he tells PEOPLE. “So I felt like even if I got some side effects from Wegovy, as long as it wasn’t one of the very serious ones, those side effects would be much less than what I experienced in everyday life.” life.”

“That’s all gone now,” adds Carlson, proud of his current weight of 170 lbs. after 11 months. “I just feel better in every way. I’ve easily added 20 years to my life. I plan on doing it forever.”

Washington Man says insurance coverage is the “one challenge” about taking Wegovy for weight loss

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