This month is kind of a mish-mash of topics, but they’re all connected. And they all matter if you’re navigating a healthcare system that feels more broken by the day.
Let’s start with what’s coming July 1:
CVS Caremark – the pharmacy benefit manager, not the retail pharmacy – is dropping Zepbound from its preferred drug list.
That means if you have CVS Caremark managing your prescriptions, there’s a very real chance your coverage for Zepbound is about to disappear – unless your employer steps in to override it. Most won’t.
We’ve been working one-on-one with our patients in the clinic to prepare, building Plan Bs wherever we can. But I’ll be honest with you:
There’s no clear alternative that’s guaranteed to be covered.
There’s no assurance that prior authorizations will go through quickly, or at all.
And we’ve heard (though not yet confirmed) that appeals may not even be allowed, even for patients who’ve been thriving on Zepbound long-term.
Let’s be clear: this is not a medical decision.
Zepbound was just shown in a head-to-head trial to outperform Wegovy in both effectiveness and tolerability.
So let’s call this what it is: a financially motivated move that’s going to leave tens of thousands of people scrambling – solely for the sake of profit.
And while we’re talking about medications, let’s talk about compounding.
If you’ve seen recent headlines about Empower Pharmacy, one of the biggest and most “reputable” compounding pharmacies in the country, it’s now under scrutiny for allegedly cutting corners on safety and sourcing low-quality ingredients while producing compounded GLP-1s.
This is exactly why we’ve stayed away from compounded medications.
Not all compounding is bad – but it’s also not always safe, and the oversight is minimal.
Our patients’ safety has always been our top priority, and we will never sacrifice that for convenience or cost.
Meanwhile…
UnitedHealthcare – one of the largest players in the insurance world – is under federal investigation for Medicare fraud and is also being sued by its own shareholders for failing to disclose financial losses after the tragic shooting of their CEO.
Insurance is crumbling. Imploding. Exploding.
More and more specialists are exiting the system and moving to direct care models like ours – not to price gouge, but because the system is no longer working for anyone.
Copays are through the roof – many of our patients were paying over $70 per visit before we left insurance.
Denial rates are rising – about 15% of claims now get rejected.
And those that don’t get denied? They often go straight to your high deductible anyway.
So let me give you a piece of advice – not just as a doctor, but as a patient myself:
Whenever you’re seeking care – whether it’s meds, labs, or procedures – know your coverage.
Call your insurance company.
Ask questions about coverage.
Write down the name of the rep you spoke to, the date, the time, and get a reference number.
And if it’s going to your deductible – which most of us never meet – before you let the lab/pharmacy/clinic put the claim through insurance, ask for the cash price.
I’ve learned this the hard way:
Using insurance doesn’t always mean saving money.
In fact, the “insurance negotiated price” is often quite a bit higher than the cost of paying cash.
Last month, I went to fill generic eardrops for one of my kids.
Insurance price? Over $45.
GoodRx price? $38.
Same drug. Same pharmacy.
My estrogen patches are almost double the cost with insurance than if I just pay cash.
So until the system gets its act together, we all have to be savvier consumers – not just in obesity treatment, but across the board.
And finally… a small but satisfying win:
WW—formerly Weight Watchers—just declared bankruptcy.
Why? Because their decades-long diet culture model of “eat less, move more” finally lost steam.
They tried too late to pivot to GLP-1s, but by then it was clear:
Obesity is a medical condition, not a moral failing.
And you knew this before the world caught on.
You leaned into science instead of shame.
You chose evidence over dogma.
And that’s something to celebrate – even when the system around us still needs fixing.
Let’s keep pushing forward.
We’re proud to be in this with you.