When Coverage is Promised—Then Pulled
- Written by Kristi Turner
I have been on a wellness journey of healing my body from the disease of obesity since May 15, 2024.
In the last 12 months I have lost 116lbs and feel that I can care for my body in the way it deserves for the 1st time in my life with the help of Zepbound.
I began this journey with insurance coverage, but lost coverage 4/22/25 due to my husband’s employer choosing to exclude obesity medications unless members went through a program that requires patients to work with physicians that are not specialized in treating obesity (primary care, family, and lifestyle specialties) to have their medication covered by our insurance.
They're even refusing for patients that have established, ongoing care with a Board Certified Obesity Specialist to continue to have their obesity medication covered if not seen by their less qualified to treat obesity physicians.
I am in an ongoing discussion with our benefits director re: this lack of coverage and the mishandling of obesity as a disease and discrimination against those with obesity in their healthcare.
I am bringing this to your attention because I don’t want to just fight for myself, I want to fight for every person suffering with obesity that is told by their employer that it’s too expensive to cover, that gets lied to and discriminated against.
I want to put as much attention on this issue as I can to help advocate for myself and a population that has been simultaneously shamed, blamed, and ignored our whole lives.
Change of PBM and Lies re: Coverage
To make matters even worse is that I was assured last Fall when we were notified that our PBM was changing that we would keep coverage as is, that I could have my Zepbound covered with a PA.
“I was even sent a formulary for 2025 showing that Zepbound was covered with a PA.”
On January 1st, I logged into my OptumRx portal it showed my Zepbound EXCLUDED. Through conversations with Optum Rx and eventually the employee benefits people,
“They told me that they debated on covering and decided it was too expensive to cover since the employer is self funded.”
In my exchange with the Director of Benefits, she made several points (happy to share original letter upon request) she denied that they weren’t covering the meds due to cost, she stated that
“GLP-1 medications are not excluded by our health plan due to cost. Wegovy and Ozempic are newer treatments that were first used to manage type 2 diabetes but have recently shown promise in helping with long-term weight management. Because these drugs are still relatively new for this purpose, evidence supporting the long-term safety and effectiveness of these medications when used for weight loss is needed before deciding how they fit into our health plan.”
She also sent me info on their Pathways Program that has NO OBESITY SPECIALISTS on staff. I can get my meds covered ONLY if I go through their program. This program consists of Primary Care, Family and Lifestyle Specialist doctors only.
So they are REQUIRING me to be treated by someone LESS qualified.
In essence they’re demanding that I must see less qualified doctors for my disease to be treated vs seeing the Board Certified Obesity specialist that I have been under the care of for over a year and have had great success with.
Is there any other disease that you think they’d require me to step down the qualifications of my provider to access medication?
"My main reason for causing a fuss isn't even for myself... I’m tired of obesity being treated as a moral failing. I want to bring awareness and fairness for people who can't or don't know how to fight for themselves."
— Kristi Turner
Below are some of the points that I have made so far in this discussion:
GLP-1 receptor agonists such as Ozempic, Mounjaro, Wegovy and Zepbound are not experimental or unproven. These medications are FDA-approved, thoroughly studied, and have been used for years in the treatment of type 2 diabetes and more recently for weight management. Their long-term safety and efficacy are continually supported by a growing body of peer-reviewed research and real-world evidence.
If CCS is limiting access to these medications due to long-term safety concerns, I would appreciate a list of other FDA-approved medications that are similarly being withheld or studied further due to long-term use concerns. This would help clarify the criteria CCS applies when determining coverage and ensure consistency in the plan's evidence-based approach.
Obesity is a recognized chronic disease, as affirmed by the American Medical Association and other medical authorities. Like any chronic condition, it deserves appropriate medical treatment to mitigate long-term complications—including cardiovascular disease, type 2 diabetes, and certain cancers. Restricting access to effective, FDA-approved treatment undermines efforts to manage a serious health condition and may lead to greater costs and poorer financial and health outcomes in the long term.
I love that CCS is giving individuals access to the Pathways Program, I believe a holistic approach including lifestyle changes is so important in the long term success of treating the disease of obesity. However, my concern is in the forced participation in the program to access life changing and lifesaving medications. I am fully committed to the lifestyle and behavioral changes encouraged in conjunction with GLP-1 treatment. I consistently follow a reduced-calorie diet, consume over 25 grams of fiber and at least 100 grams of protein daily, engage in resistance training three times per week, and perform cardiovascular exercise three times weekly. Additionally, I have completed several years of counseling with my own therapist to address emotional and psychological factors that contribute to obesity, as well as being under the care and monitored by a functional medicine and obesity specialist physician for the past year. I have lost 114lbs in 11 ½ months on the medication due to the medication allowing all of these lifestyle changes possible to maintain long term. I believe that requiring participation in a CCS-managed program in order to access medically appropriate treatment for a recognized disease is overly restrictive and discriminatory, especially for patients who are already actively engaged in comprehensive, evidence-based care outside of the CCS Wellness Center.
Finally, I would like to express concern about the mixed messages we’ve received regarding the rationale for not covering these medications outside of the Pathways Program. Your email indicated the decision is based on the need for more evidence about long-term safety and not related to cost. However, in January we were told by several CCS employees—including my husband’s union representative—that the exclusion was, in fact, financially motivated. Specifically, my husband was told via the union president that upper administration had stated the decision not to cover weight loss medications was because GLP1 medications will bankrupt employers. These contradictory explanations make it difficult to understand CCS’s policy stance and undermine confidence in the decision-making process.
Emotional Impact Of Denial and Discrimination by our Benefits
Finding Zepbound has been lifechanging. Below is an excerpt of the Formulary Exception Request that I sent to my provider to submit to OptumRx, they refused to even review it because “your employer has excluded Zepbound”:
“I have battled obesity since the age of 15, and over the years, I have tried various methods of weight loss, including low-calorie diets, low-fat diets, the ketogenic diet, weight watchers, strength training, and working with a personal trainer. Although I have had initial success with these approaches, I have consistently experienced setbacks in the long term, largely due to a persistent issue of food noise and an inability to reach satiety when eating healthy amounts of food.
I was diagnosed with polycystic ovary syndrome (PCOS) in my 30s, which has made weight loss even more difficult due to hormonal imbalances. In addition, I was diagnosed with moderate sleep apnea last year, which has had a significant impact on my quality of life. Since my diagnosis of sleep apnea, Zepbound has been approved in the treatment of moderate to severe sleep apnea by the FDA. Both conditions make it harder for me to lose weight and maintain a healthy body mass index (BMI). To further complicate my situation, I have a family history of cardiac issues, obesity, sleep apnea, and diabetes, and I believe that without the intervention provided by Zepbound, I will not be able to continue losing weight or maintain a healthy BMI. The consequences of this could have significant long-term health impacts, including an increased risk of heart disease, diabetes, and other obesity-related health complications.
Since beginning Zepbound on May 15, 2024, I have made significant progress. As of March 11, 2025, I have lost 101 pounds by combining the medication with cardio and weight training, following the Mediterranean diet, and maintaining a caloric deficit with a focus on protein and fiber. This approach has not only helped me lose weight but also allowed me to feel more in control of my eating habits, significantly reducing the constant battle with hunger and cravings that I’ve struggled with for years. Without the support of Zepbound, I believe that I will not be able to sustain these positive changes in my weight and overall health.
Considering my medical history, the family history of cardiac issues and diabetes, and the success I’ve experienced with Zepbound in conjunction with other lifestyle changes, I strongly believe that continuing this treatment is medically necessary for me to achieve a sustainable and healthy weight and to avoid an early death. Zepbound has provided me with the critical support I need to maintain a healthy weight and avoid the long-term health risks associated with obesity. ”
To find a beacon of hope (Zepbound) in treating my 30+ year battle with a disease only to have our benefits team refuse to allow me access unless I see a less qualified physician to prescribe for and treat me is devastating on so many levels.
First, the financial toll of having to pay out of pocket.
I can make it work, but I have 2 sons in college and work hard as a small business owner, I shouldn’t have to make major financial sacrifices to be receive medication for a disease that I’m working with a specialist on and having massive success with.
Second, to be lied to about coverage for 2025 and to not even have the decency to inform me of their change of coverage is disrespectful to me as a person that pays a lot of money for our coverage and was proactive in understanding my coverage.
Third, to be lied to about the motivation is upsetting. My husband and I were told in January that this was a financial decision not to cover it because they’re self funded, but when I followed up with them this month only to share a new study on the cost benefits for employers to cover GLP1s, the benefits director told me this is false and it’s because they are concerned about the long term impact of treating obesity with GLP1s.
I responded 12 days ago to this asking for clarifications, etc and so far I have had zero response. On day 8, I sent a follow up stating I was still waiting her response and 6 days later, I still have not heard back.
I understand it’s a large school system and she likely interacts with a lot of people, but I will tell you her original email spewing gaslighting and incorrect facts got sent within 3 hours of me emailing her, but when I hold them accountable for their words and actions, I get silence for 12 days and counting.
“We’re proud to stand with Kristi as she speaks out, challenges her employer, and pushes for policy change that puts patients first.”
