Washington Man Says Insurance Coverage Is the 'Only Challenging Thing' About Taking Wegovy for Weight Loss

Washington Man Says Insurance Coverage Is the ‘Only Challenging Thing’ About Taking Wegovy for Weight Loss
Washington Man Says Insurance Coverage Is the ‘Only Challenging Thing’ About Taking Wegovy for Weight Loss

Bill Carlson Bill Carlson before and after taking Wegovy

Bill Carlson had been overweight most of his life. Even after several attempts to lose weight on his own, he always ended back at his heaviest at 225 lbs., a "roller coaster ride of losing weight and then gaining it back."

The 39-year-old wasn't able to stay on top of his health until he was introduced to obesity drug Wegovy in late 2021.

Wegovy is an FDA-approved prescription medication — taken by injection in the thigh, stomach or arm — intended for people with chronic obesity. It's one of the brand names for semaglutide, which targets areas of the brain that regulate appetite.

Carlson — from Ellensburg, Washington — recently spoke to PEOPLE about the hurdles he had to get over in order to receive the obesity treatment drug, admitting that the hardest part of his Wegovy journey was "dealing with the healthcare system in the United States."

"Just getting insurance coverage and making sure that I can stay on it and keep doing it is the only challenging thing about taking Wegovy," he says. "My insurance provider covers Wegovy for weight loss, but I still had to get prior authorization through them."

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Washington Man Says Insurance Coverage Is the ‘Only Challenging Thing’ About Taking Wegovy for Weight Loss, Bill Carlson
Washington Man Says Insurance Coverage Is the ‘Only Challenging Thing’ About Taking Wegovy for Weight Loss, Bill Carlson

Bill Carlson

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Carlson says his doctor recorded all of his vitals and health information, sending it to his insurance company. However, he was shocked to learn that despite meeting all the criteria, he was initially denied coverage.

He explains that although he provided his height and weight, insurance denied coverage because he did not provide his body mass index, which is calculated using the two.

"I'm like, 'I told you I weigh 225 lbs. and I'm 5'8". You know my BMI is high.' And so then my doctor re-applied for it, but now listing the BMI explicitly, and then they accepted it," Carlson said. "It took about two months or so before I was able to get it all worked out."

After getting pre-authorization for Wegovy, Carlson then discovered that the out-of-pocket costs are pretty expensive.

"With my insurance, I do have a deductible on it," he says. "So for the first couple of months out of the year, it's expensive. It's $900. But then after that, it's $25 a month. So on average, it's about $200 a month for me, taking into account my deductible."

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man preparing Semaglutide Ozempic injection control blood sugar levels
man preparing Semaglutide Ozempic injection control blood sugar levels

Getty Man preparing semaglutide Ozempic injection

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Determined to improve his health, Carlson — a senior lead software engineer at Microsoft — started taking Wegovy, regardless of the cost, in April 2022. He admits that the pros easily outweigh the cons, seeing a change almost instantly.

"I remember the very first day I took it — it was in the evening. The next day, I got up and we had lunch, mac and cheese," he recalls. "Normally, I eat half of the box of it but I took about five bites out of the mac and cheese and I felt a feeling I've never felt before ever, which was a feeling of being full."

"I've always eaten until I feel pain or, 'The food's gone. I guess I'll stop eating.' But it was such a different feeling and I've just never experienced it," he continues. "It blew my mind. So for the first week, I was relearning how to eat, and it was insane."

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For the first two months, Carlson says he lost 2 lbs. each week before "getting into a good rhythm" of losing weight. He has lost a total of 55 lbs. so far.

During the time, his doctor wanted to monitor his blood work closely to make sure he wasn't experiencing any severe side effects from the medication.

Ania Jastreboff M.D., PhD., and obesity medicine physician scientist at Yale who does not treat Carlson, told PEOPLE that the most common side effects with these medications are nausea and diarrhea, and sometimes you can have vomiting or constipation.

"My doctor really wanted to make sure that all of the side effects were taken care of," Carlson explains. "We monitored my blood levels every month, kidney function, pancreas, thyroid, glucose monitoring, metabolic panels. We tried to stay on top of that stuff very closely. He knew of some of the side effects as far as nausea so I also got a prescription for anti-nausea medication Zofran."

Carlson, who first shared his story on Reddit, luckily only experienced occasional nausea and stomach aches from taking Wegovy, but says his health problems before taking the obesity drug — high blood pressure, elevated triglyceride levels, sleep apnea, ocular migraines, etc. — were worse to manage.

"It's hard to express in words how terrible the side effects of being obese are — you're tired all the time, going up and down the stairs you get winded, going about your day huffing and puffing, you just feel sick all the time," he tells PEOPLE. "So I kind of felt that even if I was getting some side effects from Wegovy, as long as it wasn't one of the very serious ones, those side effects would be far less than what I was experiencing in day-to-day life."

"All that is gone now," Carlson adds, boasting his current weight of 170 lbs. after 11 months. "I just feel all around better in every way. I've easily added 20 years to my life. I'm planning on taking it forever."