u/doubleshotofespresso

Well friends, here’s the story.

I wanted to share my situation because I know a lot of people here have dealt with insurance issues and interruptions.

I started Zepbound May 2025 and worked my way up slowly (4 weeks at each dose). I made it up to 15mg pretty smoothly and tolerated it really well and literally never had any side effects other than once at the very beginning at 2.5 and one other time where I felt nauseous, but went from 311 lbs to 157 lbs and was still losing about 1 lb/week by that point and was SO close to my goal of 150 when I had to stop because of insurance. My lack of side effects and super-responder loss of almost half my body weight in 13 months made me feel like this medication was made for me, but employment changed and coverage at the new job was switched over to the dreaded CVS Caremark.

Caremark for my specific plan still excludes Zepbound but they do cover Wegovy with a PA. The agents on the phone said since I never tried Wegovy, no matter what is in the PA, I would be denied because I did not have exclusionary criteria for a preferred agent (Wegovy). I was approved Wegovy PA. I was switched to Wegovy and was put on the 0.25 mg and wanted to give it an honest shot since, if it did work, that meant I didn’t have to go through another arduous PA process and fight insurance. Well, this was a terrible mistake.

I found myself eating much larger portions than I could on Zepbound and was unable to stop, slipping back into binge eating. I had pretty significant GI side effects and was nauseous every single day, waking up with terrible stomach pains that lasted much of the day, and I was horribly constipated. When I finally could go, I would have diarrhea and then subsequently returned to constipation.

I gave it the first week because I thought it was due to adjustment period. I did another shot for a “true trial” and symptoms persisted the entire second week too. Mistake 2. I should have quit the day after taking shot #1 to get the PA business rolling again. I told my doctor during week 2 but delays with the office, back and forth, planning another PA, etc this all ate up a ton of time. and here we are an additional 2 weeks later.

Alarmingly, my weight went from about 157 to 164 during this past month.

It did suppress food noise sufficiently though but like I said, it caused GI problems, caused me to eat a ton, and led to weight gain

I’m now restarting Zepbound. My provider sent me 2.5 mg, which I understand is the safest/conservative restart, but I’m struggling with the idea of potentially needing months to titrate back up when I was previously stable on 15 mg. I voiced this, and it was offered to me to go to 7.5 but we discussed risks and how at this point I have pretty much no more Zepbound in my system and still having bad side effects from Wegovy, it may be a bit much for me. I ultimately chickened out and agreed to just take the 2.5 again before making any rash decisions. Mistake 3 (possibly). I was kicking myself either way. At least this way I know I will tolerate the titration but it may prolong my time to effective dose, it’s the safest option.

I’m so scared of reversing everything I’ve worked so hard for and undoing all the progress. I am never going back. This has to end. The weight gain has seemed to have settled for now, but I am so paranoid that these next 6 months of titrating again I am going to gain more weight

I’m wondering if anyone has been in a similar situation.

I’m planning to have a conversation next appointment about possibly going from the 2.5 straight to 7.5 given that I tolerated the medication for 13 months the first time, the last 6 of which was at 15. Any suggestions/thoughts?

I hate how insurance can take us from the MAX dose of a medication and force us to go on the LOWEST dose of a worse medication that is less effective and has worse side effects. I hate how it’s not possible to get pens individually to customize dose titration for people who may not require the standard dosing ladder. I hate how little agency we have and these giant companies get to dictate our bodies and mess with our hormones and endocrine system on a rollercoaster ride when EVERYTHING WAS PERFECTLY FINE. I hate how Caremark makes this announcement that they are going to cover Zep again but do not make it effective immediately and I hate they made these backdoor deal decisions for what they are covering to begin with.

Thanks for reading