Finding the Right Obesity Treatment is Only the Beginning

Story from OAC Member Meladee N.

If you had asked me years ago whether I thought I would spend decades searching for the right obesity treatment, my answer would have been a definite “yes.”

Over the course of my life, I followed commercial weight-loss programs, medically supervised diets and plans that promised lasting results. My story is similar to many others’ living with obesity – some worked for a while. None worked for long.

In 1997, I underwent gastric bypass surgery when I weighed 382.5 pounds. At first, I lost more than 160 pounds, reaching 220 pounds before my weight plateaued. Over time, the weight gradually returned. Eventually, I weighed 302.5 pounds and was living with several obesity-related health conditions.

At 5-foot-8, my body mass index (BMI) was 46 and I knew I needed another option. Unfortunately, I quickly learned that finding the right treatment was only part of the challenge. Access to that treatment was another, separate, part of the challenge.

In late 2022, I asked my primary care provider about different GLP-1 options. At the time, my clinic wasn’t prescribing GLP-1 medications for obesity, so I found a telehealth provider that could prescribe Ozempic from Canada. It wasn’t covered by insurance and I paid cash because I believed my health was worth it.

A few months later, I enrolled in an online weight-loss program that successfully obtained prior authorization for Wegovy through my insurance. My monthly cost dropped to just $25 and I finally found a sustainable path forward.

Then another obstacle appeared. The program failed to submit accurate renewal paperwork for my prior authorization, and my coverage was denied. 

My primary care provider prescribed Zepbound, successfully obtained approval and my insurance covered it, until the CareMark changes in 2025. I had to return to paying cash through LillyDirect because I wasn’t ready to lose access to the treatment that had helped me rebuild my health. By the time the Medicare GLP-1 Bridge Program was announced, I had learned not to assume anything would be simple.

Before my appointment, I printed information from the CMS website, highlighted the sections that applied to me, including my starting BMI, obesity-related health conditions and prior authorization requirements, and brought everything with me to my primary care provider.

The next day, I carried the same information to my pharmacy and the process still wasn’t smooth. There were several days of back-and-forth between my healthcare provider, the pharmacy and me before everything was finally approved. When I picked up my prescription, I felt grateful because another chapter of uncertainty had come to an end.

Today, I weigh 140 pounds and have a BMI of 21.3. People sometimes assume that reaching my goal weight means the journey is over. That’s never been true. I often describe myself as a “GLP-1 lifer” because obesity is a chronic disease. Reaching a healthy weight didn’t mean my disease disappeared, but that I found a treatment that works for me.

My hope is that one day, people living with obesity won’t have to spend years navigating denials and complicated approval processes just to continue or obtain the treatment that helps them live healthier lives.

New programs and healthcare policies can be confusing and complicated. Check out OAC’s Medicare GLP-1 Bridge Resource Hub for everything from guides on talking to your healthcare provider and pharmacist, to the most frequently asked questions about the program and eligibility.