Healthcare costs vary, and so do insurance copays, deductibles, contracts, and fee schedules. We all have learned to deal with it —kind of.
Weight loss injections are currently the center of this debate. Let’s discuss the lack of transparency in pricing within this hot market.
If you have enough “qualifying conditions” that the insurance payors have deemed you eligible for semaglutide or tirzepatide brand-name prescriptions such as Ozempic and Mounjaro, then you might not be guessing quite as much as the rest of us. For the purpose of this article, I am going to focus on semaglutides.
I’ve seen varying copays and deductibles with massive patient responsibility increases from month to month, even with a prescription. I’ve also seen some patients denied coverage despite having “qualifying conditions.” What does it take for an insurance company to deem you eligible, anyway? It depends on BMI and comorbidities. It depends on the payor. It depends on the rules that the payor has decided on that month without regard to the patient as a whole person and without consideration to where that patient is in life and why how they got there.
For the rest of us, the floodgates have opened. The medication is close to magic with changes in our patient’s weight and other conditions as we’ve never seen before in healthcare. Because of the shortage of supplies, compounding pharmacies have made medication available. Because of the wide adoption of telemedicine since COVID, getting a prescription for the injections is as easy as a few clicks.
Yet, those embedded in traditional healthcare prescribing brand names to those “eligible” who don’t mind dealing with pre-authorizations caution the rest of the prescribing community and patients that using a telemedicine prescriber and compounding pharmacies could be dangerous. Additionally, there is widespread judgment of those who want to try semaglutides when they don’t technically “qualify.”
Then there are those of us who think that our patients shouldn’t gain five pounds a year for the next ten years until they eventually develop diabetes. We believe if you start early, you’ll have more significant effects and be happier. We believe that the food industry and public health sector have failed our country by allowing so much use of pesticides, growth hormones, and processed food. Our food portions are too large, and the cost of food is too high. It’s easier and more affordable for people to eat fast food or processed food than real food. We’ve failed, yet we judge something that can help us level the playing field with seemingly little risk.
Those who decide to move forward are left with a big unknown: how much does it cost?
That depends. It shouldn’t, but it does, and as long as healthcare is the broken system it is, it will.
The starting dose of semaglutide is .25 mg, given weekly for one month. The maximum dose is 2.4 mg. Most patients will not stay on .25 mg or even .5 mg. When you see the advertised price of semaglutide, it is almost guaranteed that it is the initial starting dose price.
Without insurance, the cost of a 1-month supply of Ozempic can range from $800 to over $1,000, depending on the dosage. This high price is prohibitive for many patients unless they have insurance that partially or fully covers the medication. Even with insurance, co-pays can be significant. True story: I had a patient who could get Ozempic via her insurance. When she went to the pharmacy to fill her prescription, her co-pay was $800.
Enter telemedicine companies, med spas, naturopaths, and chiropractors. For simplicity’s sake, let’s call them prescribers. We’ve all formed relationships with compounding pharmacies that we trust to bring widespread awareness and access to the magic juice. Those who are not prescribing yet will. It’s inevitable.
Trust and/or cost are likely the only two factors that patients will consider when deciding where to get theirs.
Those who have established relationships with med spas, dermatologists, naturopaths, etc., will likely pay a higher fee for the trust and convenience of already being established with that prescriber.
But cost is all over the place, and it’s not easy to figure out. Many online companies require you to complete all of the required screening questions, sign up as a patient, and even pay the first month (or 12) before you can even begin to see what the next level pricing might be.
Let’s look at a few specifically.
Hers.com. This telehealth provider charges $199 per month for semaglutide but requires users to sign up for a 12-month subscription, paying the full $2,388 upfront. It’s important to note that this price covers the 0.25 mg dose, and if you want to increase the dose (which many patients do as treatment progresses), the cost will likely rise. Unfortunately, details on how much more you’ll pay for higher doses are not provided upfront.
Levity.com: Levity.com charges $225 per month for semaglutide, but users cannot increase their dose beyond 0.25 mg. What?
Ziphealth.com: Ziphealth.com advertises semaglutide for $149 per month, which appears to be the most affordable option. However, there is no clear information about how much the service will cost after the first month or whether patients can increase their doses. This lack of transparency makes it difficult to determine the true long-term cost.
A local provider just sent out an email blast advertising $1250 for six weeks of injections and wellness visits, bringing the weekly price to $208. Again, is this for .25 mg? A week?
Why is there such a lack of transparency around pricing? It must be similar to uncomfortable questions such as how much you earn each year or how much you weigh. But it shouldn’t be like that, especially when patients are paying cash and there are no health insurance variables to consider.
To be fully transparent, here is the cost of each dose each week with Instaclinic.com. We email this to all of our new patients after their first visit or before if they would like to review it first. There is an additional $15 shipping from one of our pharmacies and an additional $45 shipping from the other. We use the $15 shipping pharmacy if the patient lives in a state they deliver to.
| Transparent Pricing | ||
| Patient Charge | Patient Dosages/week | Patient cost per week |
| $200 | 0.25 | $50.00 |
| $225 | 0.5 | $56.25 |
| $250 | 0.75 | $62.50 |
| $275 | 1 | $68.75 |
| $325 | 1.5 | $81.25 |
| $375 | 2 | $93.75 |
| $450 | 2.4 | $113.00 |
There are no other costs.
We believe in accessible, transparent healthcare. We always have and always will.
For more information, visit www.instaclinic.com.
