How does the Medication Coverage Guarantee work?
Initial Medication Coverage
We guarantee that the initial cost of your GLP-1 medication with insurance will be $25/month or less after any deductible is met, or you’re eligible for a refund minus the $250 Metabolic Health Assessment cost. Our team is committed to working with your insurance company and exploring all possible medication coverage options (including patient access programs) so you don’t have to. Take our Insurance Quiz to see if you’re eligible for our Medication Coverage Guarantee. Please note that for members that have been enrolled through an employer, this Medication Coverage Guarantee does not apply.
In some cases, Calibrate may use manufacturer patient access programs for eligible patients to reduce your initial medication cost to $25/month or less. These manufacturer programs are subject to change, and may only cover access for a certain period of time (e.g., six months). If the Calibrate team obtains cost-effective coverage for you via a manufacturer patient access program, we will notify you of this as part of our standard medication approvals process, which occurs within eight weeks of your doctor appointment. At this point, you may request a refund (minus the $250 Assessment cost) and exit your One-Year Metabolic Reset if you do not wish to accept medication coverage via a manufacturer patient access program. By continuing and accepting medication coverage via manufacturer patient access program, you waive your right to a future refund should the terms of the manufacturer patient access program change or should your access expire.
You can request a refund if you do not receive initial coverage of GLP-1 medication for $25/month or less after any deductible is met once the Calibrate Support team has worked through all standard medication approval processes, which can take up to eight weeks after your doctor appointment. If we have not helped you obtain GLP-1 coverage for $25/month or less after eight weeks from your doctor appointment, you can request a refund by emailing firstname.lastname@example.org. If a Calibrate team member has already reached out to you regarding your coverage status and you wish to cancel your membership, you can do so by responding directly to that message.
The Medication Coverage Guarantee only applies to the initial coverage of medication for your first full year on the One-Year Metabolic Reset (i.e., does not apply for Masters members).
Ongoing Medication Coverage
Medication coverage for the duration of your Calibrate Year is not guaranteed and may not be clinically appropriate. Your Medical Team will work with you to adjust medication as determined based on your progress, and can include medication changes and adjustments as well as clinically appropriate duration of use.
If you switch insurance or your existing insurance has a change in policy it is possible you will lose access to low-cost coverage. The Calibrate team will explore all possible options to help you maintain $25/month or less coverage, but in the event there are no low-cost coverage options available, you will not be eligible for a refund since we were able to obtain your initial medication coverage.
Terms subject to change. If you have chosen to pay for GLP-1 medication out-of-pocket (self-pay) you waive your right to a refund via the Medication Coverage Guarantee.
If you are eligible for a refund per the Medication Coverage Guarantee, you will receive a refund per our refund policy.