By: ARIEL J. WARDEN-JARRETT, MD, FAAFP

Many Americans are working hard to manage their weight and have set goals to lower their body mass index (BMI)  to under 25. While this is a worthy goal, it can often feel like a challenging and sometimes frustrating journey. But the good news is that there are more resources and options available today than ever before to help patients achieve their weight management goals. 

However, navigating the world of insurance coverage can add complexity to the process. Many patients experience disappointment when they go to the pharmacy to pick up a prescribed medication and discover that it is not covered or isn’t listed on their insurance’s drug formulary. They are often advised to contact their doctor’s office to request a prior authorization or a tier exemption. While it sounds simple, these processes can sometimes be more time-consuming and challenging than anticipated. 

In each of our offices there are dedicated individuals working behind the scenes to get your medications covered. Sometimes each prior authorization may take significant time to complete and we appreciate your patience as we manage these requests. 

It’s also important to understand that your employer plays a significant role in selecting your insurance benefits and choosing which medications are covered. Many patients may not realize this. 

If a medication like Mounjaro or Ozempic, which is often prescribed for diabetes, isn’t covered for someone who isn’t diabetic, this is typically due to how the insurance policy is structured. If the medication doesn’t align with the required coverage criteria, even with a prior authorization, it may not be approved.

Additionally, starting in January 2025, some insurance plans will no longer cover medications like Zepbound or Wegovy for obesity alone, making it more challenging to get these treatments covered under certain plans.

So, what can you do if you’re facing these challenges?

1. Talk to your employer: If you find that your medication is no longer covered or the coverage is limited, it may be helpful to ask your employer about the available options or if there’s anything that can be done to improve coverage.
2. Work with your healthcare provider: Your doctor or healthcare team can help explore alternative treatment options and lifestyle modifications that may be beneficial in reaching your weight management goals. Together, you can find a plan that works for you.
3. Check for manufacturer assistance programs: Many pharmaceutical companies offer discount programs or coupons to help offset the cost of medications. If you’re able to pay out-of-pocket, it might be worth exploring the cost of the medication without insurance, though be aware that these payments won’t apply toward your deductible.
4. Advocate for change: If you’re facing difficulties with your insurance coverage, consider reaching out to your congressperson or state representatives to share your concerns. They are there to represent you, and they may be able to assist in advocating for changes or improvements in the system.

Remember, you’re not alone in this process, and we are all working together to find the best solutions for your health and well-being. Don’t get discouraged – there are resources available to help, and your healthcare team is here to support you every step of the way.

By: ARIEL J. WARDEN-JARRETT, MD, FAAFP

It’s an election year. It is no secret that as a nation we seem politically divided, and more than ever before. It may surprise you that your response to “politics” can impact your health.

During the last presidential election, I noticed that some of my patients developed high blood pressure, depression, anxiety, and insomnia based on the election results. This reality further opened my eyes to the indirect and direct political influences that potentially impact the health of an individual, family, community, state, and nation.

Here are some tips to get you through a politically charged season.

1. Make sure you exercise your right to vote. Vote for candidates and issues that best align with your values.
2. If you find that your heart races or you get angry listening to the news, then limit the time you spend watching or listening to the news, and try not to do it before bedtime. Get your rest!
3. At the end of the day, you can cast your single vote. Don’t lose energy worrying about things that are out of your direct control.
4. Artificial Intelligence (AI) is on the rise. It can be used to educate you with facts and fiction. Don’t believe everything you hear, see or read on social media. Fact-check information from trusted sources.
5. Ask yourself if the candidate you are seeking to elect can be trusted to represent you. Will they vote for what is in the best interest of your district, county, state or nation?
6. Develop positive coping skills to help prepare for election results, especially when they don’t go the way you hoped and/or voted.
7. Talk with your family as well. Remind them of the core values of what it means to be an American. We are a great nation that fights for liberty and justice for ALL. We may not always agree, but our core values as Americans should shine above our differences.
8. Hold your elected officials accountable. Make sure you know who represents you! Introduce yourself to their office and share your stories with them.
9. Don’t get worked up about things you can’t change! However, be safe. Since the nation is politically divided, exercise caution with how and with whom you share your political views. Push yourself to grow and look at issues through multiple lenses. Enter a growth mindset zone.
10. If you don’t like things, get involved! Become a part of the solution. Don’t let the circumstances consume you.

My 97-year-old patient shared with me that she has seen so many different presidents in her lifetime. Each has a special stamp to leave in history. Focus on the positives no matter the outcomes. After all, there will be another election….

Learn more: How to Best Communicate with your Care Team