T2D Insurance Services
T2D.com is focused on helping individuals secure compounded GLP-1 medications that are safe, reliable, continually available and affordable. T2D.com does not make anything from the medication itself, and instead the only revenue that T2D generates comes from our monthly subscription fee. This fee gives our members access to our pharmacies and ensures that those pharmacies are providing GLP-1 medications at (wholesale) the lowest price possible.
Our core mission aside, many T2D.com members use our service as a back-up in the event their brand medication becomes unavailable. This ensures there is no gap in your treatment so that your treatment can be continued without interruption. This allows you to receive the maximum benefits for the least amount of money for your GLP-1 medication.
Another benefit of the T2D.com service is our expertise in helping members navigate their healthcare coverage options. Regardless of your age or your current health insurance coverage, T2D.com can help you obtain the answers you need in regard to seeing if your insurance or medicare coverage can help reduce the cost of GLP-1 medications.
Below you'll find some information in regard to GLP-1s and their general coverage options, along with some additional information in regard to the general availability of these medications and typical out of pocket costs. In the example belo re have outlined a scenario in which someone with medicare coverage might be researching their options. Regardless of the coverage you have and the state you live in, T2D.com can schedule a call with a licensed insurance professional to answer questions that you may have about your options.
Understanding Out-Of-Pocket-Costs for Ozempic & Mounjaro (Medicare Member)
Ozempic and Mounjaro without insurance can range from $1,000 - $1,500 a month for the medication. With insurance it can be as little as $15 a month copay, but that is based on your initial coverage under your medicare Part D plan. Once you hit your coverage gap in your Part D coverage, the policyholder is responsible for a % of the total cost of the medication until you reach your catastrophic coverage amount. That amount is typically $8,000 in out of pocket expenses for medications.
You must also consider your other expenses for your medicare coverage. Part B premium, MAPD or Supplement premium, Part D premium, additional medication costs, Dental, Vision, Hearing and any other supplemental coverage you may need. These costs can definitely add up quickly and ultimately result in having to pay the full co-pay amount for a Tier 3 drug like Ozempic or Mounjaro.
In this example a popular plan choice for individuals seeking a medicare advantage plan in Palm Beach County, Florida is the HumanaChoice Florida H5216- 068 PPO plan. According to the drug formulary filed by Humana, any individual that is seeking to have a Rx covered is going to have a financial responsibility of approximately $8,000 in total out of pocket costs.
Keep in mind, any other medication expenses that fall under your plan is still counted towards the max out of pocket limit. This means that if you have monthly medication expenses that already exhaust the total allowable, you may end up paying the full co-pay amount initially instead of having to do so later.
This means that for the example plan above, under a schedule in which medications haven't exhausted the GAP coverage, the co-pay schedule for Mounjaro would result in copayments of $47 for the months of January through April. Then in the month of May it increases to $125. From June through December the copay increases to $267 a month.
If the allowable is exhausted earlier, other medications that they use - it could mean that the copay is $267 per month starting the first month January, running through to December.
If you would like to see all of the medicare plans that have Mounjaro, Ozempic or any other medications in their formulary, you can do so by navigating to MedicareEnrollment.com and using their plan comparison tool. This gives you the ability to see exactly what medications are covered by a carrier's plan.
Still have questions? Confused by all of the insurance terms, don't worry! Trying to read and truly understand all of this information can often be difficult.
Feel free to connect with a licensed insurance agent that's legally permitted to provide guidance in regard to medicare coverage options along with answering any of the questions you may have.
2.5mg Mounjaro Cost Breakdown by Month and Coverage Period
Can I Find The Medication At My Pharmacy?
Once you know which plan is best suited for your needs the next step is to understand if it's possible to find the medication and ensure it is going to continually be available. If a medication is “on short” it means that the supply that is continuously available does not meet the demand coming from patients.
As of August 1st, 2024 all brand name GLP-1 medications such as Ozempic, Mounjaro, Wegovy, Zepbound are all currently short listed medications. So while it's great if your insurance plan covers the medication, the real problem can be ensuring that you can continuously get access to it. The primary reason that T2D.com exists as a service is because the medical need in the type 2 diabetic, pre-diabetic and general medical community (actual medical necessity) in total represents more than 100 million adults in the United States of America. It is highly unlikely that the manufacturers of the brand medications (ElyLilly and NovoNordisk) can produce enough supply to meet the needs of the approximately 100 million adults that these medications are a fit for.
Because these medications are injected there is a “shelf life” or “stability period” of 60 to 90 days. As such it is not possible to produce a surplus of the medications to be stored and then distributed as needed. This is ultimately the issue driving the seemingly growing shortage of brand name GLP-1 medications.
These are a few of the most popular Medicare plans in Palm Beach County, FL. The total annual out-of-pocket cost for Mounjaro ranges from $2,147 - $2,502.
