Will Medicaid Cover GLP-1s for Weight Loss? DOWNSIZED NEWS

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  • Опубліковано 27 лис 2024

КОМЕНТАРІ • 50

  • @Elizabeth_Parsons_327
    @Elizabeth_Parsons_327 Місяць тому +9

    When I tipped the scales at 260lbs+ I had a VSG (the sleeve) in 2010 but only got to about 160lbs. Revised to a duodenal switch in 2016 and quickly lost the rest, actually getting to a low of 118lb before regaining and stabilizing at 145 after a few years. Food noise was constant, but restriction helped keep the weight off and manageable. Then I hit menopause and ballooned up to 170lbs+ the last couple of years. Pretty despondent since I've exhausted the surgical route, and then I found these meds!!! THIS is the 'brain surgery' part of bariatric surgery doctors lecture about. After just 3 months, I'm back to 135lbs and will take this shot for the rest of my life. Having the food noise cancelled at last is absolutely amazing & it allows me to make better choices for adding fuel to my body because I'm not driven by the addiction.

    • @thedownsized
      @thedownsized  29 днів тому +2

      Thanks for sharing! I love the “brain surgery” concept. It certainly has changed the way we think. You should join us to tell your story in a interview

    • @ediecostello
      @ediecostello 29 днів тому +2

      I had vsg 2016 then revision to bypass 2021 to lose my COVID 40 lb gain lost that but never got below 189 with either surgery was 197 when I started shots 3 months ago 181 yesterday so far lowest weight in over 24 years

    • @rvmush3883
      @rvmush3883 26 днів тому

      Totally agree. Had the surgeries but never could get rid of the brain issues. Now I have a way to actually stay at a healthy weight.

  • @terriburgeson7710
    @terriburgeson7710 Місяць тому +6

    Really appreciate all the information that you are providing.. thank you! I am a fairly new subscriber😊
    I had the gastric sleeve surgery in 2012 paid out of pocket. It cost me 16,000. I lost 110 lbs, changed my lifestyle, no more starchy foods or processed foods, AND exercised every day. I kept it off all these years, but was unable to lose anymore. Was totally stuck.. food noise always so loud, A1C number stuck at 6 or above. 3 months ago went on terzepitide per Dr's advice and have dropped from 179 to 153 but the best part was that my A1C down to 5.2, and body pain from inflammation had all but gone for the first time in decades. (I am 67 yr female). So even though i would like to drop another 10 lbs, I could be ok where I am at.. but body pain would be hard to have to deal with again. I am waiting in line for a appt. From my dr. to get a new script in order to purchase from compounding pharmacy again hoping that this doesn't go away...as my insurance will not cover any of this..😒

  • @rdavis46
    @rdavis46 Місяць тому +7

    You mention about weight loss surgery. I had gastric bypass surgery July 2009 and you are right that you do gain weight back as over time your stomach stretches back out. Zepbound has been a game changer I been on 15 mg for like 5 months now.

  • @ranihurd248
    @ranihurd248 29 днів тому +2

    Laraine and Chris thanks as always for a great update. Laraine would you consider making another video on what you ate in a day for weight loss and what you eat now for maintenance with calorie targets. There are a lot of us your height and your age and it would be very insightful! Thanks!

    • @thedownsized
      @thedownsized  29 днів тому

      I mean, I could give guidelines, but my diet has been/ is far from perfect! But maybe I will just to show how you should eat what you like, eat protein first, and it’s ok not to have a perfect diet! 😍

  • @jc10907Sealy
    @jc10907Sealy Місяць тому +2

    My endocrinologist and cardiologist would approve me for bariatric surgery. I’ve seen my friends and family suffer with that invasive procedure, and I’ve seen many with great success. Just didn’t want it did myself. I’m so glad I held out for these developing GLP medicines.

  • @ediecostello
    @ediecostello Місяць тому +13

    Minutes ago I just text from Eli lily they are extending my 550 a month to 6/2025 instead of terminating it on 1/2025

  • @olgarivera1245
    @olgarivera1245 Місяць тому +8

    But Nova Nordick hasn't said anything in the last 2 years that the compound has been prescribed. They only did it because Eli Lilly did the same back over the summer.

  • @michaelclanton1152
    @michaelclanton1152 Місяць тому +2

    I am going to pass on the GLP-1medicaid chart to my friend on Medicaid just starting on compounded she is also in low income bracket. Ty for the updates.

  • @rdavis46
    @rdavis46 Місяць тому +3

    I am on Wisconsin medicaid and was approved for zepbound for 6 months, had to lose 5% to get approved again which I lost 20% and was recently reapproved. My son and daughter both have medicare which they don't cover it but they do have Wisconsin medicaid so we had to first go thru medicare, wait for the denial then doctor had to send PA to medicaid which took a month to get approved so they are approved until March 2025. They just started on it. Ozempic was bad for both of them due to the side effects and really didn't lose weight they both have very high BMI. I hit my goal of 150 today started at 207. Not sure how long medicaid will continue to pay for it.

  • @rvmush3883
    @rvmush3883 26 днів тому

    I’ve done all the diets, had bariatric surgery and a surgery to fix it, then semaglutide. While I lost about 180 on surgery, I regained 50. Semaglutide has been a game changer. I no longer think about food all the time and have cravings. I actually changing my relationship with food!

  • @maribethclark2798
    @maribethclark2798 29 днів тому +1

    The sentence are in all studies that more research needed. Although these medications are expensive, so is dialysis. 2 or 3 times weekly let's say $5,000.00 per session vs preventing type II diabetes!!
    How about Lilly & Norvo Nortis be pressured to get the price down??

  • @Stephen4438990
    @Stephen4438990 Місяць тому +1

    Thank you for these news-related videos, well done.

  • @JessicaH533
    @JessicaH533 Місяць тому +2

    I’ve been a subscriber for a few months and really enjoy your coverage of the GLP-1 world. I have heard that cardiovascular disease is a reason for the GLP-1 medications to be covered by Medicare. Do you have any information regarding this? My doctor requested a prior authorization for Mounjaro be prescribed for me because of high BMI, high blood pressure, high cholesterol, sleep apnea and pulmonary problems and the first submission was denied. We are going to appeal the decision and hoping it will be approved

    • @thedownsized
      @thedownsized  Місяць тому

      Unfortunately, medicare does not typically cover weightloss medications

  • @johnnaledoux2554
    @johnnaledoux2554 Місяць тому +7

    Seems like there’s a way to fight this discrimination between weight loss and other health benefits. Why is not obesity cared for like everything else?

  • @jazzymdg7170
    @jazzymdg7170 Місяць тому

    Thank you very informative

  • @Susansnewera
    @Susansnewera Місяць тому

    Bariatric bypass 2021. As long as you control yourself you have a forever tool. Bypass decreases absorption versus sleeve removes up to 80 % stomach. Doctors offered sleeve. I did my research and asked RNY bypass. I must have done well because insurance approve. I will be taking bariatric vitamins the rest of my life. My labs perfect every way last 3 years. My bone density strong. 3 years happy and I’ve easily maintained weight loss. I just got on long plateau 185 pounds and zepbound help me to get in 150’s. Don’t want too many pounds off I have larger frame. I’m not a delicate wispy lady. Very happy with zepbound and RNY surgery. By the way with RNY surgery-I have all my parts that could be reconnected if got sick. Sleeve 80 % stomach gone fore ever

    • @thedownsized
      @thedownsized  29 днів тому

      That’s a fascinating story - thanks for sharing. You should join us for a interview on the Downsized Dish

  • @MomOfSeven123
    @MomOfSeven123 Місяць тому

    Are there links to the articles listed somewhere?

    • @thedownsized
      @thedownsized  Місяць тому +1

      The relevant links are in the description

  • @marawilliams8024
    @marawilliams8024 Місяць тому

    Had to have my beloved but broken (6yrs ago) lap band removed recently and surgeon talked me into gastric sleeve but after jumping through all the hoops for surgery, decided to give Tirzepatide a shot…started about 6 weeks ago…..nauseous quite a bit but down 13 lbs…way better than forever altering my body to sustain itself on food meant for a bird. Just as I made that decision I learned about the shortage issue and now so worried I made the wrong decision.

    • @thedownsized
      @thedownsized  29 днів тому

      Hang in there- the shortages will resolve eventually

    • @rvmush3883
      @rvmush3883 26 днів тому

      Right there with you. My band almost killed me. Emergency surgery to remove. Stomach so badly scared that surgeon required a year of recovery before the sleeve. Thankfully I found GLPs before that surgery.

  • @JamiGoss-f3h
    @JamiGoss-f3h Місяць тому +2

    Elderly diabetics are worth saving…but those with cardiovascular disease are not. Imagine if these peptides were actually discovered when looking for a way to reduce heart attacks, and found that they could also control diabetes 🤷🏻‍♀️.

  • @valerieSMITH-l7e
    @valerieSMITH-l7e Місяць тому

    Medicare COVERS
    The surgery!

  • @ediecostello
    @ediecostello Місяць тому +1

    Wondering if you found a different between aequita and Hallandale when you switched I has name brand , empower and aequita I noticed a big difference between empower and aequita just wondering if it is me when I post in the Facebook group they decline my post ??

    • @thedownsized
      @thedownsized  Місяць тому +2

      CD: we have used ZepBound, mounjaro and compounded Tirzepatide from hallendale, redrock and aequita and seen no difference.

    • @mahnitmac7070
      @mahnitmac7070 Місяць тому

      @@ediecostello what is the "big difference" that you noticed? Did Empower not work for you.?

    • @ediecostello
      @ediecostello 29 днів тому

      @@mahnitmac7070 I thought empower worked better Aequita I thought didn’t work as well even when I upped the dose an extra .5 mg but I am only only 4.5 not even 5 mg yet.

  • @simonesobel7882
    @simonesobel7882 Місяць тому

    Blue shield of California has denied my doctors prior authorization for zepbound three times plus denied a grievance. I mean zepbound is FDA approved for weightloss, and i have the BMI requirement but they still deny. They wrote a whole list of what I need to reapply for it. One of the things was get on a weight loss program they approve of (like the blue shield wellness) for 6 months and if it fails they'll consider getting it for me. My doctor listed all the programs/apps/diets/hypnotherapy program I've tried but that wasn't good enough for them. I'm wondering if anyone actually does a six month program, what kind, and what the result was.

    • @brianne571
      @brianne571 Місяць тому

      What about wegovy? Is it ca medicaid?

    • @thedownsized
      @thedownsized  29 днів тому +3

      Those programs are not designed to succeed they are designed to delay the insurance paying out and they hope you change your mind.
      If the programs actually worked there would be no need for the meds.

    • @NorthlandSLC
      @NorthlandSLC 29 днів тому

      I have blue cross in Michigan, same thing. Tons of hoops for the doctor to do, forms etc. Then another teli health appointment with approved blue cross doctor and enrollment in their program which has no physical location where I am. The recommended “diet” and food is the standard low nutrient carb dominant diet that my personal doctor said to avoid. Blue cross will be dropping all glp’s in January even with the program. They won’t be covered in any way after dec.

    • @simonesobel7882
      @simonesobel7882 29 днів тому

      @@NorthlandSLC that's so sh-tty. So many people are going to be screwed.

  • @pamelamason3781
    @pamelamason3781 Місяць тому

    I paid $10,000 cash for the sleeve

  • @normaskroch
    @normaskroch Місяць тому

    what about medicare?when will they pay?