Weight Management Knowledge Center
Whether you’re a patient or a doctor, here are some frequently asked questions about our weight management program.
Program overview
For patients
Who can participate in the weight management program?
This program is for patients who are:
- 18 or older and
- Have a BMI >= 30 kg/m2 OR a BMI of >=27 kg/m2 or greater with at least one weight-associated comorbidity such as type 2 diabetes, hypertension, obstructive sleep apnea, or dyslipidemia
What happens at the first visit?
At your first visit, you’ll meet with a doctor to review your medical history and weight loss goals. Your doctor will discuss treatment options and develop a personalized care plan for you, which may include medications. If necessary, your doctor may also order labs and biometrics for you to complete.
Are weight loss medications prescribed at the first visit?
This depends on your care plan and the status of your labs. If your doctor does not have all of the needed lab work and biometrics, they won’t be able to prescribe medication at the first visit. Instead, they will schedule a follow-up visit in 1–2 weeks to review your lab results.
How often will I see my doctor while my medication is being titrated?
You’ll see your doctor about once a month during the titration phase.
How often will I see my doctor once I am on a maintenance dose?
Follow-up visits will be every 2–3 months depending on your treatment plan.
What medications do you prescribe?
Frequently prescribed medications for weight management include:
- GLP-1 Receptor Agonists, such as semaglutide (Wegovy® or Ozempic®), Liraglutide (Saxenda®), and Tirzapatide (Zepbound® or Mounjaro®)
- Orlistat
- Contrave®
- Metformin
Are there any medications you do not prescribe?
Our doctors do not prescribe phentermine, phentermine/topiramate (Qsymia), or other controlled substances.
Do you send medications or refills to compounding pharmacies?
We do not send prescriptions to compounding pharmacies.
Is there anything I can do before my first visit?
If you’re interested in taking anti-obesity medications, specifically GLP-1s and Contrave, you can contact your health insurance company and ask if these medications are covered specifically for weight loss.
Will my health insurance cover GLP-1 medications?
Coverage depends on your medical history, insurance, and previous weight loss attempts. You should call your insurance company to determine if GLP-1 medications are covered for weight loss.
What is the prior authorization (PA) process?
If you want to use your insurance, a prior authorization is usually required. The process usually takes 7–14 business days, and you’ll be informed of the result.
What is needed for a prior authorization (PA) to be submitted?
In order for a prior authorization to be submitted, the following conditions must be met:
- BMI >=30 or >27 with an obesity-related condition like type 2 diabetes, hypertension, hyperlipidemia, or obstructive sleep apnea (OSA)
- Enrollment in a comprehensive weight loss program or weight loss support group for 6 months
- Labs and biometrics completed within the past 60 days
- List of weight loss medications taken in the past, including how long you took them for as well as when and why you stopped taking them
- A completed weight management intake—these questions are part of the prior authorization requirements
What is required for a prior authorization (PA) to be approved for a refill of a medication that I’ve been taking?
If you’re already on a GLP-1 and a prior authorization is required for continuation of therapy, you must show documentation of 5% weight loss.
How do I store my medications??
You can find this information on the manufacturer’s website. Here are some links for common medications below:
- Ozempic®: FDA-approved to treat type 2 diabetes,and for cardiovascular events risk reduction – DM type 2 pt/ w /established cardiovascular disease. Not weight loss.
- Saxenda®: FDA approved for chronic weight management
- Zepbound®:FDA approved for chronic weight management
- Wegovy®: FDA approved for chronic weight management
For referring doctors
If you’re a referring doctor, please note that we do not typically prescribe medications on the first visit as it is meant to be a comprehensive evaluation and review. In order to prepare a comprehensive evaluation, the following labs and measurements should be completed within 60 days of the patient’s appointment with a Cedars-Sinai Connect doctor:
- CBC
- CMP
- A1c
- Lipid panel
- TSH with reflex to T4
- Height, weight, BMI, pulse, and blood pressure
We also will not automatically submit prior authorizations or appeals to prior authorization denials. Doctors will assess each case individually.
Additionally, we do not locate medications for patients, nor do we have any nutritionists, dietitians, or behavioral health specialists on our platform. We will refer patients to these specialists when indicated.
GLP-1s and lifestyle changes
Glucagon-like peptide-1 (GLP-1s) receptor agonists are a class of medications including medications like liraglutide and semaglutide. These medications work by binding to and activating the GLP-1 receptor which enhances insulin secretion and slows gastric emptying. Tirzepatide is a dual GLP-1 and glucose-dependent insulinotropic polypeptide (GIP) agonist. GIP is a hormone that works with GLP-1 to encourage the body to secrete more insulin and slow down gastric emptying.
Healthy lifestyle changes to diet and activity work together with medication to help you lose weight and keep it off. There are many diet plans out there, and the right plan for you depends on your own unique circumstances! The following general principles are a good place to start when trying to lose weight:
- Avoiding unhealthy, ultra-processed foods of minimum nutritional value such as sweets, junk foods, cakes, cookies, candy, pies, chips, and ultra-processed meats such as bacon, sausage, hot dogs, pastrami.
- Eating more healthy proteins and fats (e.g., fish, lean meats, olive oil), vegetables, leafy greens, fruits, berries, nuts, legumes, and whole grains. For foods with a significant amount of fat, higher levels of unsaturated fats and lower levels of saturated fats are the better options.
- Limiting your caloric intake to fewer calories than your body uses in a day is important for weight loss. Low calorie diets range from 1,200–1,800 kcal/day (1,200–1,500 for women, 1,500–1,800 for men), depending on individual circumstances.
- Along with dietary changes, increasing your activity level is a cornerstone of weight management and can drastically improve your overall health. The CDC recommends at least 150 minutes of moderate–intense physical activity per week. The best type of activity is any activity that you enjoy and will be able to do consistently. Some people enjoy more social options such as Zumba or other exercise classes, while others may prefer a calming walk or run by themselves. Whatever works for you is the right choice—all you have to do is get moving!
FAQs
Prior authorizations
What’s a prior authorization and why is it needed?
A prior authorization is a process in which a health insurer determines whether a service, prescription, or treatment is medically necessary. If a prior authorization is required for a medication, we will not find out until after we send the prescription. The prior authorization process normally takes ~10 business days.
Why can’t I get this medication today?
In order to receive medications, you will need to get your labs and biometrics completed first. This is a requirement for the prior authorization.
Why won’t you send a prior authorization even if my doctor prescribed medication?
We will not send a prior authorization if you do not meet the requirements of your insurance. Additionally, sometimes your insurance will not cover certain medications even if they are medically indicated.
What is needed for a prior authorization to be completed?
In order for a prior authorization to be completed, you must:
- Have a BMI >=30 or >27 with an obesity related condition such as diabetes mellitus type 2, hypertension, hyperlipidemia, or Obstructive Sleep Apnea (OSA)
- Be enrolled in a comprehensive weight loss program or weight loss support group for 6 months
- Complete labs and biometrics within the past 60 days
- Report which weight loss medications you’ve taken in the past, how long you took them for, when you stopped taking then, and why they didn’t work
Will my insurance cover GLP-1 medication?
Please contact your insurance company to see if GLP-1s are covered under your specific plan.
How long will it take before I can get my prescription and why does it take so long?
Please contact your pharmacy to better understand when you can receive your medication. If your pharmacy doesn’t have a specific medication due to national shortages, you’ll be added to their waitlist.
How often do we have to renew the prior authorization?
This depends on your insurance provider. Please note that all prior authorizations have an expiration date.
What’s a pharmacy benefit manager?
A pharmacy benefit manager, or PBM, helps manage your prescription drug benefits. Pharmacy benefit managers:
- Negotiate discounts by working with drug manufacturers to lower medication costs
- Manage formularies and create lists of covered medications
- Process claims by handling prescription transactions between pharmacies and your insurance
- Network pharmacies and help you find places to fill prescriptions
- Ensure appropriate usage through programs that make sure medications are used properly
- Support patients with services like mail-order and specialty pharmacies to help manage medications
PBMs aim to make medications affordable and accessible while ensuring quality care.
How will I know when my prior authorization is approved?
Once your prior authorization is approved, you will be contacted by your pharmacy benefit manager. The clinical operations team will also contact you via the care team chat.
Can I use a compounding pharmacy?
Currently, we do not offer compounding options.
Can I get a printed prescription?
No, all prescriptions are sent electronically to your pharmacy.
Can you send my prescription outside of California?
No, we are unable to send prescriptions outside of California. The only exception is that we are able to send prescriptions to mail order pharmacies.
Pharmacy
My pharmacy is out of this medication. What should I do?
Specific mediations (e.g, GLP-1s) can be difficult to find within pharmacies. It will be your responsibility to contact the pharmacy and confirm that the medication is in stock.
If your preferred pharmacy does not have the medication, you should call other local pharmacies to see if they have your medication. You might need to call pharmacies outside of your area to locate the medication.
Once you find a pharmacy, you can send this information via the care team chat on Cedars-Sinai Connect and we will have your medication sent there.
You can also contact the pharmacy to see if they have ordered this medication for you.
What happens if I switch pharmacies?
You can ask the new pharmacy to contact the original pharmacy to have your prescription transferred.
Alternatively, you can send the new pharmacy information via the care team chat on Cedars-Sinai Connect and we will have your medication sent there.
What if I can’t find the medication anywhere? Do we have to start over?
All prior authorizations have expiration dates. The expiration date for your prior authorization is determined by your insurer.
If you have been unable to obtain the medication and the expiration date of your prior authorization approval has passed, new labs and biometrics must be completed in order to submit a new prior authorization request to your insurer.
What happens if I travel out of state/country?
Please schedule an appointment to speak with your provider prior to traveling to discuss the logistics of your medication therapy.
The pharmacy says that they are waiting for approval from my doctor. What does that mean?
The pharmacy will not be able to process your prescription until your insurer has responded to the prior authorization request we submit on your behalf.
If your insurer approves the prior authorization request, we will notify you via the care team chat. Once that happens, you can notify your pharmacy of the approval and they will be able to process your prescription.
Paying for medication
What if my copay is too high?
You can schedule a visit with your provider to discuss alternative medications that may have a lower copay.
You may qualify for savings through the manufacturer or you can use a third party service like GoodRx for assistance with out-of-pocket costs.
Can I pay for a prescription without insurance and get reimbursed later once my prior authorization is approved?
Whether or not you have insurance, you may qualify for savings through a manufacturer. If a prior authorization is denied or if you do not have insurance, you can use a service like GoodRX for assistance with out-of-pocket costs. Here are a few resources:
- Savings and support | NovoCare® (Wegovy)
- https://www.novocare.com/ozempic/savings-card.html (Ozempic)
- https://www.novocare.com/saxenda/savings-card.html (Saxenda)
- https://zepbound.lilly.com/coverage-savings (Zepbound)
- https://mounjaro.lilly.com/savings-resources (Mounjaro)
- https://www.goodrx.com/conditions/weight-loss/drugs (GoodRX)
Medication preferences
Can we start with Zepbound?
Some insurers will not cover Zepbound until other weight loss medications have been tried first.
Can we use Mounjaro instead of Zepbound? My insurance “covers” Mounjaro.
Mounajro is FDA-approved to treat type 2 diabetes, not weight loss. Most insurers will not cover Mounjaro for weight loss. However, Zepbound is FDA-approved to treat weight loss.
Can we use Ozempic instead of Wegovy? My insurance “covers” Ozempic.
Ozempic is FDA-approved to treat type 2 diabetes, and cardiovascular event risk reduction for DM type 2 patients with established cardiovascular disease, not weight loss. Most insurers will not cover Ozempic for weight loss. However, Wegovy is FDA-approved to treat weight loss.
Denials
My prior authorization was denied. What are next steps?
If you have further questions about your denial or wish to discuss an appeal, please contact your Cedars-Sinai Connect care team to discuss. If you would like to talk about alternative medications or treatment options, please schedule a visit with your provider.
Why didn’t my insurance approve my medication?
Your insurer will send you a denial that should include the reason for the denial. These reasons can include but are not limited to:
- The medication is excluded from coverage under your pharmacy benefit plan
- You did not meet a clinical requirement (e.g., BMI <27)
- You did not meet a diet/lifestyle requirement (e.g., 6 months participation in a comprehensive weight loss program)
- You must try an alternative medication first
Why would my insurance not pay for this medication?
Each insurer has their own list of criteria that must be met in order to approve coverage of a medication. If you do not meet the listed criteria, your insurer may deny coverage.
What does it mean that this isn’t a “covered benefit” and what do we do from here?
Each insurer has their own list of medications that they provide coverage for. This is called their “formulary.” If a medication is not found on your insurer’s formulary, it may be excluded from coverage under your pharmacy benefit plan.
Appeals
Why won’t you appeal my denial?
We will not appeal if:
- The medication is not a covered benefit
- You have not completed the required steps (e.g., if the denial states that you have to complete 6 months of supervised weight loss and you have not completed that yet)
How do we appeal a denial?
The denial letter you receive from your insurer will have details regarding the submission of appeals. Your care team is happy to provide you with any clinical documentation requested by your insurer for the appeal request.
How soon can we appeal the denial?
You can appeal a prior authorization denial immediately.
What is the status of my appeal?
Your insurer is allowed 30 days to respond to an appeal. It is best to follow up directly with your insurer to inquire about the status of your appeal.
Can my doctor call my insurance company to appeal their decision?
Most appeals are initiated via fax.
Refills
What is required for a prior authorization to be approved for a medication that I have been taking but need a refill on?
If you are already on GLP-1 and a prior authorization is required for continuation of therapy, you must show documentation of 5% weight loss.
Other
Why do I have to pay a monthly copay to see you for refills?
Our program requires monthly check-ins with a provider until you reach a maintenance dose of the medication. These check-ins are scheduled for your safety. Your provider will discuss any side effects you may be experiencing and how well the medication is working for you.
If my medication does not require a prior authorization, why is the medication so expensive?
Each insurer decides what portion of a medication’s cost they will cover. Unfortunately, our team cannot effect a change on the cost of your medication. However, you may qualify for savings through the manufacturer or you can use a service like GoodRx for assistance with out-of-pocket costs.
Open enrollment is coming up soon. Is there a better plan than the one that I have?
Unfortunately, our team does not have insight into different health plans. Reach out to your insurance company or your employer to help you find the right resources.
