Fighting to Maintain Access to the Care That Helped Her

For years, Carol tried different approaches to manage her weight. She tried keto, cutting out carbohydrates and even severely restricting how much she ate. Some approaches worked for a while, but they were difficult to maintain. Then, during a routine physical, her doctor offered her Zepbound.

“It was a game changer,” Carol said.

For the first time, Carol felt like she had found a treatment that worked for her and could be part of her long-term approach to managing her health. Her prediabetes was being managed, and she began to feel differently about herself and her future. But the changes went beyond her physical health.

Finding a new sense of self

Carol had spent much of her adult life feeling defined by her weight. Even when her doctor encouraged her not to focus on BMI charts, the labels stayed with her.

Through counseling and treatment for anxiety, Carol began to develop a greater sense of self-awareness and acceptance. She says she finally started to understand that her worth was not determined by her weight. That shift affected her entire life.

Taking care of her disabled husband began to feel less like a burden, and Carol found a greater sense of happiness and worthiness. For her, continuing treatment is about more than maintaining a number on a scale. It is about maintaining her health, well-being and quality of life.

The challenge of affording treatment

Keeping access to Zepbound became difficult when the cost was no longer manageable. Carol was paying out of pocket for her medication and, when she could not afford it, turned to compounded versions.

She knew compounded medications were not FDA-approved versions of Zepbound, and she did not feel comfortable having to rely on them.

When Carol learned about the Medicare GLP-1 Bridge Program, she thought she had finally found a way to maintain access to the treatment that had become an important part of her care. Instead, she found herself facing another barrier.

When a form stands between a patient and care

Carol and her healthcare team ran into difficulties with the Proof of Authorization form. One question asks whether she has prediabetes. Because her condition is currently managed, her doctor answered no, despite her documented history of prediabetes.

Carol says her doctors were concerned about the program’s guidelines and did not feel comfortable signing the form based on her medical history. She spent hours researching the program and trying to find answers, but still could not get the guidance she needed.

“I know I qualify for this program,” Carol said. “If you call Medicare 10 times, no one understands this form, and you will get a different answer every time.”

The uncertainty has taken a toll. Carol says her anxiety has increased significantly throughout the process, and she has needed an adjustment to her anxiety medication. She is now planning to work with a weight management clinic within her healthcare system, hoping the team can help her navigate the program and submit a new prior authorization.

In the meantime, she has had to return to compounded medication. Carol’s experience is a reminder that access to obesity care does not end with a prescription. Patients can face financial barriers, complicated coverage requirements and uncertainty about how to navigate the system, even when they are working closely with their healthcare providers.

She hopes sharing her story will help others who are facing similar challenges feel less alone and encourage patients to keep asking questions when the path to care is unclear.

If you’re navigating the Medicare GLP-1 Bridge Program, OAC has resources to help. Visit our Medicare GLP-1 Bridge Resource Hub for the latest information, frequently asked questions and tools to help you talk with your healthcare provider and pharmacist.