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Evidence-based GLP-1 & peptide discussion since 2023
ForumsInsurance & Access2026 payer coverage update — GLP-1 formulary changes by insurer Page 5

2026 payer coverage update — GLP-1 formulary changes by insurer

InsuranceTom Fri, Dec 1, 2023 at 4:00 PM 54 replies 42,238 viewsPage 5 of 11
marcus_mpls
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Nov 2024
Minneapolis, MN
Dec 1, 2023 at 11:05 PM#21

pam_columbus — that is really helpful context on 2026 payer coverage. Follow-up question: did you change anything about your diet at the same time?

I am in a similar situation (month 2) and trying to set realistic expectations.

1 7bbq_ray_KC
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SarahChen_PharmD
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Dec 2023
San Diego, CA
Dec 1, 2023 at 11:22 PM#22

To answer TinaHashiRN's question specifically:

From a clinical standpoint, 2026 payer coverage update is well-supported by the literature.

The short answer: follow the standard titration protocol and reassess at 4-6 weeks.

The longer answer involves pharmacokinetic considerations around steady-state concentrations, which I am happy to elaborate on if helpful.

10 3NurseKim_ATL, paul_denver, TinaHashiRN and 7 others
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nick_SD_fit
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Sep 2024
San Diego, CA
Dec 1, 2023 at 11:39 PM#23

marcus_mpls — wow. This community is amazing.

47 3EndoResFellow, PharmacoVig_BOS, SurmountFan_IN and 44 others
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josh_phd_bmore
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Jul 2024
Baltimore, MD
Dec 1, 2023 at 11:56 PM#24

Adding my data to this 2026 payer coverage discussion:

MetricBaselineMonth 3Month 8
Weight250 lbs225 lbs195 lbs
A1C6.4%5.8%5.4%
hsCRP4.02.00.8

Protocol: Semaglutide 2.4mg/wk, resistance training 3x/wk, protein 1.2g/kg/day.

Last edited: Dec 2, 2023 at 1:56 AM
23 20KarenAZ_mom, zoe_NC, Dr.ObesityLA and 20 others
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KetoKyle
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Jul 2024
Utah
Dec 2, 2023 at 12:13 AM#25

Slightly tangential to 2026 payer coverage but marcus_mpls reminded me — does anyone have experience combining this with metformin?

I know it is not exactly on-topic but it seems related enough to ask here rather than starting a new thread. Apologies if this has been covered — I did search first.

Last edited: Dec 2, 2023 at 1:13 AM
1 6JakeBK_lifts
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