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Evidence-based GLP-1 & peptide discussion since 2023
ForumsInsurance & AccessHow is this not covered but my coworker gets Viagra no questions asked Page 2

How is this not covered but my coworker gets Viagra no questions asked

TomFromTexas Wed, Feb 11, 2026 at 11:17 AM 31 replies 862 viewsPage 2 of 7
rick_sfbay
Member
289
1,234
Jan 2025
San Francisco, CA
Feb 11, 2026 at 2:07 PM#6

UPDATE: PA submitted yesterday, approved this morning. Less than 24 hours. I've been fighting for coverage for 14 months and it took less than a day once it was actually on formulary.

My new cost: $25/month with the Zepbound savings card stacking on top of my $50 specialty copay. Down from $549/month.

I'm going to save $6,288 this year. I genuinely cannot stop smiling.

10 10mike_mealprep, NicoleRaleigh, james_edin and 7 others
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Dr.CardioMD
VIP Member
2,678
14,567
Dec 2023
Cleveland, OH
Feb 11, 2026 at 2:24 PM#7

Love seeing this! And for anyone whose employer currently excludes GLP-1s, here's what you can do:

  1. Write a professional letter to your HR/benefits department requesting the exclusion be reviewed
  2. Include data on cost-effectiveness (JPMorgan's internal analysis showed net savings within 2 years of adding GLP-1 coverage)
  3. If your company does an annual benefits survey, advocate loudly for GLP-1 coverage
  4. Connect with other employees who want coverage — there's strength in numbers

Most employer plans renew annually. Changes requested now could take effect at the next plan year. Don't give up — the trend is clearly moving toward coverage.

5 14Dr.NephBHM_UK, kim_atl_prep, sarah_TO and 2 others
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amsterdam_pete
Senior Member
1,567
6,789
Feb 2024
Netherlands
Feb 11, 2026 at 2:41 PM#8

Pharmacy side update: we've been seeing a FLOOD of new Zepbound PA approvals through UHC this week. Our pharmacy filled more Zepbound prescriptions yesterday than in the entire previous month.

Heads up: there may be short-term supply pressure as demand spikes. If your pharmacy is out of stock, ask them to check other locations or consider the mail-order option through OptumRx (UHC's pharmacy benefit manager). Mail order has been more reliable for supply in my experience.

Also: make sure you enroll in the Zepbound savings card BEFORE your first fill at the new copay. It's free to enroll and could save you $25-50 per fill depending on your copay tier.

Last edited: Feb 11, 2026 at 8:41 PM
37 6CanadaChris, ZaraB_AL, JakeSmashed95 and 34 others
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ricardo_MIA
Member
378
1,678
Sep 2024
Miami, FL
Feb 11, 2026 at 2:58 PM#9

Happy for those of you who got coverage. Genuinely.

I took the advice and emailed our benefits team. They said they'll "bring it up at the Q3 benefits review." It's not a no. Small progress.

In the meantime, I'm staying on compounded tirzepatide at $199/month. It's working great for me (down 43 lbs) and honestly, even if my employer adds coverage tomorrow, I might stick with compounded. No PA hassles, no formulary changes, no pharmacy games. There's something to be said for simplicity.

Last edited: Feb 11, 2026 at 7:58 PM
23 12KetoKyle, CanadaChris, ZaraB_AL and 20 others
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