Talking to your doctor about GLP-1 Medications

*not medical advice* *this is getting really long*

It’s Thursday, which is GLP-Fun update day, but this week has been pretty boring. I went up to 5mg and…nothing happened.

But while we’re here, I thought I’d publish a little guide to talking to your doctor about GLP-1 medications. I am doing that with a few disclaimers:

1. By posting this, I’m not telling you that you need to go on one of these medications. I’m not even telling you that you should entertain the idea. I’ve just been asked about it so much, it would be good for my spoons to have all the information in one place.

2. The information forthwith could be triggering, because I do have to mention BMI and weight. We all know BMI is BS, but when writing about the ways our capitalistic society likes to classify these meds for insurance purposes, it is sadly unavoidable.

3. Everything I write here will only be from my experience and research and I won’t possibly be able to cover everything about these meds.

4. I will not even attempt to discuss compounded GLP-1s. Compounded GLP-1s are not FDA approved, and are versions of the medications custom-made by specialized pharmacies using the ingredients of semaglutide (production of compounded tirzepatide ended last month) and combining them into a finished product that can be sold without a prescription. Because they cannot sell the pure form of the medication, most compounding pharmacies or med spas make minor changes to the inactive ingredients and add things like vitamin B12 or saline. These compounds are significantly cheaper than the FDA approved medications and readily available, but you really need to know what you’re using and who you’re buying from if you go this route.

What even are GLP-1s?

GLP-1 (glucagon-like peptide-1) agonists are a class of medications used to treat type 2 diabetes and obesity. They work by mimicking a natural hormone called GLP-1, which helps regulate blood sugar levels and promote feelings of fullness.

No one should use these medications if you or anyone in your family has ever had a type of thyroid cancer called Medullary Thyroid Carcinoma, or if you have an endocrine system condition called Multiple Endocrine Neoplasia syndrome type 2. Also, if you have pancreatic issues or already have slowed gut motility, it’s probably to be avoided.

There are a few medications on the market. Some of the most well known are Exenatide, Liraglutide, Dulaglutide, Semaglutide, and Tirzepatide. I focused in on Semaglutide and Tirzepatide in my research.

Semaglutide

Semaglutide is approved by the Food and Drug Administration as 3 different brand names. This is where things will start to be familiar to you. The brands are Ozempic, Wegovy, and Rybelsus. Each brand name comes with different usage indications, dosing considerations, and preparations. But they’re all the same drug - semaglutide.

Ozempic and Wegovy are injections, and Rybelsus is a tablet.

So why is the same medication branded 3 different ways? Largely, to avoid shortages and for insurance classifications.

Wegovy

Wegovy is FDA approved for what they deem as “chronic weight management.” Essentially, it is FDA approved for an adult with a BMI of 30 or more, or a BMI of 27 or more and a “weight-related” health condition, like high blood pressure, high cholesterol, or cardiovascular disease.

Ozempic

Ozempic was approved in December 2017 for the treatment of type 2 diabetes in adults. To be eligible for an Ozempic prescription, patients must have type 2 diabetes that is not controlled by other medications, have a BMI of 30 or higher, or a BMI of 27 or higher and at least one “weight-related” health condition. These are classified as high blood pressure, high cholesterol, and heart disease. Sometimes, insurance companies will require proof of failure of other treatments before they approve Ozempic, like working with a nutritionist for a specific amount of time and not losing weight or seeing your A1C improving, or taking Metformin for a while and seeing no improvement.

Rybelsus

Rybelsus is the first oral GLP-1 medication available in the US and was approved by the FDA in 2019. It’s approved to improve glucose levels in adults with type 2 diabetes.

Tirzepatide

Like Semaglutide, Tirzepatide has different brand names with different use indications. The brands are Zepbound and Mounjaro. Again, they’re literally the same drug.

Zepbound

Zepbound is the brand name for the medication tirzepatide when doctors prescribe it for weight management only. Zepbound comes in three doses, 5, 10, and 15 milligrams. In December 2024, the FDA approved Zepbound for the treatment of moderate to severe obstructive sleep apnea in adults with obesity.

Mounjaro

Mounjaro was approved by the FDA in 2022 for the treatment of type 2 diabetes in adults. In late 2023, the FDA approved the use of Mounjaro for weight loss as Zepbound. It comes in 2.5, 5, 7.5, 10, 12.5, and 15 mg per 0.5 mL injections.

So what’s the freaking difference?

First, the two drugs are made by different companies. So of course, there’s competition. Novo Nordisk makes Wegovy and Ozempic, and Eli Lilly makes Zepbound and Mounjaro. Lilly is based in the US and Novo Nordisk is in Denmark.

Both drugs work in similar ways to reduce appetite, but tirzepatide is known as a “dual-agonist” drug, while semaglutide is a “single-agonist” drug. Basically, tirzepatide is a new drug class that’s a combination peptide and dual-agonist approaches seem to cause people to lose more weight than semaglutide, which activates one hormone pathway. Semaglutide activates the GLP-1 pathway, and tirzepatide activates both GLP-1 and GIP. GIP is glucose-dependent insulinotropic polypeptide (say that 3 times fast) - a hormone that stimulates insulin secretion, which helps regulate blood sugar after a meal. GIP has been called an “obese hormone” because people who are obese tend to have higher levels of GIP. Tirzepatide directly activates the GIP receptor and helps mimic the hormone and stimulate the pathway correctly.

How did I get it?

Well, your girl has insulin resistance, and your girl went into this with a BS BMI of 34.5. You can read more about my initial journey here, where I detailed my doctor’s rationale for prescribing and the battle with the insurance company to get any sort of traction. That post also explains my first week in deep detail, if you’re like me and love to read about experiences from the start.

I do want to spend a little time breaking this down with what I’ve learned.

Insurance companies really don’t like approving these meds for weight loss

It’s universally really very difficult to get Wegovy or Zepbound approved by insurance when you’re solely going for it based on weight. In addition, most employer prescription insurance plans exclude GLP-1s for weight management completely. These medications also require a prior-authorization from your prescriber, where they have to try to prove to them that it’s medically necessary. And again, even then, they may make you work with a nutritionist for a while.

It is easier to get an approved prescription for Ozempic, Rybelsus, and Mounjaro - because of the insulin resistance and type 2 diabetes element. Because I already had the diagnosis and had been on Metformin, my doctor did not have to submit prior authorization for it to be approved.

If you’re interested, it’s worth calling your insurance first. Tell them you’d like to look into whether GLP-1 medications are covered by your insurance plan. But know that they can be sneaky. My pcp initially was putting in prescriptions for Zepbound, because I’m the first person she’s prescribed tirzepatide for and we didn’t understand the difference. When it was denied because my insurance does not cover GLP-1s for weight loss, I called and they told me that I had no alternative medication options because they were solely looking for weight loss. I had just learned about Mounjaro and asked them to check because of my diagnoses, and SURPRISE - covered at $25 a month with no prior authorization. So I’d recommend calling and just listing each medication and asking whether it’s covered. Seriously.

Why did I choose tirzepatide?

There’s more about this in my original post, but first, I liked the idea of trying the dual-agonist approach. But I also have lymphedema and lipedema, and I read stuff like this: https://ctv.veeva.com/study/tirzepatide-reversal-of-lipotoxicity-and-adipose-tissue-dysfunction-in-humans-with-overweight-obesi and this https://www.frontiersin.org/journals/pharmacology/articles/10.3389/fphar.2024.1457363/full and this https://pmc.ncbi.nlm.nih.gov/articles/PMC10198595/ and this https://www.news-medical.net/news/20230609/Common-diabetes-drug-prevents-the-development-of-long-COVID-study-finds.aspx and I lost my mind.

Costs

The cost of these medications is wild. Like, thousands of dollars a month. Both Novo and Lilly have “savings cards” - like this one for Ozempic - where you only pay $25 a month if you have insurance that will cover the med. It’s the same for Mounjaro. If your insurance doesn’t cover the meds, you can use the saver cards for extreme discounts, like going from $1600/mo for 4 doses to a low low $800 something! Oof. Because my insurance covers Mounjaro for my insulin resistance, I’m paying $25 a month for 4 pens. There’s no way I could do this otherwise.

So, in summary

Semaglutide and tirzepatide are two different GLP-1 medications. Semaglutide works on one hormone pathway and tirzepatide works on two. Both drugs have different brand names indicated for either weight management or treatment of type 2 diabetes. Zepbound is the brand of tirzepatide that’s FDA approved for weight management and moderate to severe sleep apnea. Tirzepatide seems to show promise for helping with lymphatic issues as well as targeting lipedema tissue that Semaglutide does not. I got prescribed Mounjaro, the brand of tirzepatide that’s FDA approved for treatment of insulin resistance and type 2 diabetes. Call your insurance company and ask them if specific brand names are covered. Saying “tirzepatide” or “semaglutide” won’t matter to them because they’ll assume you’re calling for weight management only. People with specific health issues cannot take these medications, and they are not without side effects, but they all seem to be highly individualized.

I highly recommend checking out the Reddit forums for all of these medications and reading personal experiences. It’s also very helpful to search them for your insurance company - folks in these groups are experts and update whenever there are any changes.

Do not think that getting on one of these meds is an easy way out. You can’t just take the shot and then eat anything you want and make no changes. I was very skeptical and a bit of a hater in the past because that’s what I assumed everyone was doing. It is NOT like that. What it is like is every bit of hard work you’ve ever tried in the past but gave yourself hell about not being strong enough to maintain actually work because it was never about your willpower and determination and strength, it was about how your hormones were or were not working. You’re still doing the work, making lifestyle changes, working on your mental health, and battling with the way the changes to your body may or may not trigger you while your blood sugar stays steady and you feel less icky. I highly recommend doing this in tandem with working with a therapist if you have a history of any sort of issues in this area.

Also, if you’re like, I want to try these but I don’t want everyone to know. Who’s gonna know? How are they gonna know? You don’t have to tell them. You don’t. You can. But you don’t have to. And if do decide to try one and you see external physical changes? Just say something like, “I think I must have found the right combination of meds for my long covid.” Or “maybe the damage long covid did to my metabolism/hormones is regulating.” Neither are lies!

I hope this was helpful. Let me know if you have more questions.