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I just learned that I have about $2k in a health reimbursement account that I have to "use or lose" before going on Medicare next month, so I decided I'd like to try one of these new weight loss drugs (that amount should cover the initial and a refill, or two months' worth, and give me a good jump start on my weight loss). Although I'm definitely overweight at 145 and just 5'0" tall (BMI of 29), I was told by my doctor through a message that I "don't qualify" for it. Is there a particular level of "fatness" that I'd have to achieve first? I wonder if he's confused and trying to tell me that insurance wouldn't cover it because I'm not diabetic (of which I'm aware; this isn't insurance, but to pay for out-of-pocket expenses insurance doesn't cover). Should I pursue this and try to clarify, or is he correct that I'm "too thin" to even warrant a prescription - insured or not - for weight loss purposes? Anyone had trouble getting it even on their own dime? I feel like I'm the only overweight person NOT taking it at this point!
Last edited by otterhere; 01-26-2024 at 04:53 PM..
The first person I'd ask for clarification is the doctor who denied it.
That's what I tried to do, except that I had to go through a middleman. I can't talk directly to him without an appointment, and he doesn't have any appointments before my funds expire.
I think you have a BMI of 28.3. I used this site to calculate it using your data. You are not obese, just overweight. More than 30 is considered obese.
Maybe if you are able to measure the percentage of fat (a different thing/test) on your body, and maybe if the fat is more around the waist or inside the body/organs etc. It might be an issue for your health and you might qualify.
I wasn't aware that one had to "medically qualify" for its use just for weight loss purposes. Does one, in fact, have to be clinically obese even if one is paying out of pocket for it?
Yes, it's used now for treatment of obesity, not for general weight loss. It's a potentially dangerous drug, with some pretty serious potential side effects. At 5 feet tall, 145 pounds isn't that big a deal. If you lose only 10 pounds you'll feel and look better, you don't need prescription meds for a 10-pound loss.
Yes, it's used now for treatment of obesity, not for general weight loss. It's a potentially dangerous drug, with some pretty serious potential side effects. At 5 feet tall, 145 pounds isn't that big a deal. If you lose only 10 pounds you'll feel and look better, you don't need prescription meds for a 10-pound loss.
Except that I CAN'T lose ten pounds (I'm also post-menopausal with a very slow metabolism). If I lose one or two, I gain it right back. This is where my body wants to be, apparently. If I completely stopped eating, I'm sure I'd eventually lose, but that ain't happenin'.
So you DO have to reach a certain level of fatness to get a prescription written, even if insurance isn't involved at all.
Is that what I'm hearing?
I'm like one number away from "obesity" and am probably not even 5'0" anymore, truth to tell (my chart just took my word for my height, and that was years ago). It seems like quibbling...
Health expenses payable from an HRA must be qualified as designated by the IRS. This is because an HRA receives tax benefits.
Only eligible with a Letter of Medical Necessity
Weight loss programs or drugs are eligible for reimbursement with flexible spending accounts (FSA), health savings accounts (HSA), and health reimbursement accounts (HRA) with a Letter of Medical Necessity. They are not eligible for reimbursement with dependent care flexible spending accounts and limited-purpose flexible spending accounts (LPFSA). https://www.healthequity.com/hra-qme
You are not paying out-of-pocket from your income, which would have been subject to taxes. You are paying from non-taxed funds.
What is Wegovy®?
WEGOVY® (semaglutide) injection 2.4 mg is an injectable prescription medicine that may help adults and children aged ≥12 years with obesity (BMI ≥30 for adults, BMI ≥ 95th percentile for age and sex for children), or some adults with excess weight (BMI ≥27) (overweight) who also have weight-related medical problems to help them lose weight and keep it off. Wegovy® should be used with a reduced calorie meal plan and increased physical activity https://www.wegovy.com/taking-wegovy...govy-pen.html?
Of course this medication could be contraindicated if there are other medications, side effects, etc.
So if my BMI were 30 and not 28.5, I would "qualify" for "a letter of medical necessity" and therefore a prescription? Maybe I should go somewhere for exact measurements and not estimates.
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