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Getting Your Medication Guide

Starting any new medication can be complicated. At Calibrate, we work to provide as smooth a transition as possible onto your GLP-1s. And it begins right here, with this step-by-step explainer that answers most questions our members have, and provides resources for any that remain. 

Overview

If you don’t have time to read this entire guide, here is the most important information you need to know.

  • It typically takes 6-8 weeks after your Calibrate doctor’s appointment to get approved for your medication, but in some cases, it can take up to 90 days.
  • If we aren’t able to get access to a GLP-1 medication for less than $25 per month (after any deductible has been met) for you within 90 days of your doctor visit, we will notify you via the Support Center in your Calibrate app. 
  • Once notified, you may request a refund and exit the program, or choose to stay in the program covered by our Calibrate Results Money Back Promise.

The teams behind getting your medication

Calibrate uses a team-based approach to coordinate your care. Here’s a quick rundown of the teams who will have your back throughout your time with Calibrate.

The Medical Team is responsible for evaluating your health, determining the appropriateness of medication, managing your medication dose, and helping you taper off your GLP-1 medication when you reach clinical milestones. 

The Benefits Navigation Team works with external pharmacies, monitors nationwide GLP-1 medication inventory and helps you receive your medication as quickly as possible. Note: Calibrate is not a pharmacy and we don’t receive any compensation from prescribing medications.

The Support Team is here to connect the dots between you and the teams above. Think of your Support Team as the central command center for your time with Calibrate.

How you’ll get your GLP-1 medication 

Once you’ve met with your Calibrate doctor for your video visit, they will review which GLP-1 medications are clinically appropriate and covered by your insurance plan. If you are clinically cleared to start a GLP-1, then they will send an e-prescription to your pharmacy of choice––all typically within 24 hours of your appointment.

Next, the Benefit Navigation Team will determine if a Prior Authorization (PA) is required by your insurance company, and will complete one if necessary. A PA is an extra step insurance companies take to review your case and make sure that your prescription meets the medical criteria for coverage. 

It is not uncommon for multiple PAs to be submitted before access is approved, meaning the wait may vary by member. As a result, while it typically takes 6-8 weeks after your Calibrate doctor’s appointment to get approved for your medication, in some cases it can take up to 90 days.

If a PA is approved (or if it’s been determined that a PA is unnecessary), your Calibrate Medical Team will send your prescription to your pharmacy. Be aware that the name of the doctor on your prescription may not be the same as the doctor you saw. This isn’t a mistake. We use a team-based clinical practice model, which enables us to provide the most timely, efficient, and safe care to all of our members. 

What to know about medication cost 

We work to get your medication cost to $25 once you’ve met your insurance deductible. This isn’t an arbitrary number; it’s a reflection of the goalpost that manufacturers set and to make sure it’s met, they issue coupons that can be added to your post-insurance medication cost if it winds up being higher than $25. 

There are various types of coupons in the market. Some come out when new meds reach the market and are often available only for a limited time. Others are standard practice and usually always available. The latter are used widely and frequently by Calibrate, other prescribers, and pharmacies.

In either case, if your prescription cost is greater than $25 a month, please do not accept the prescription. Instead, contact us via the Support Center in your Calibrate app, and we’ll follow up with your pharmacy to ensure your insurance is being billed correctly and that any relevant savings cards have been applied.

Communication from Calibrate about your medication

We aim to communicate regularly and proactively with you about your medication approval status. Below is an outline of the communication you can expect to receive from us, as well as what you can expect to hear from your insurance plan. All messages—aside from the final notification from your pharmacy—will appear within the Support Center of your Calibrate app, so make sure you have your push notifications on for Calibrate’s app so that you never miss a message.

  • Within 24 hours of your video doctor visit, you’ll receive a message from a Calibrate doctor. 
  • This next update you’ll receive will be once your PA has been approved. This message will come from your PBM or your insurance plan. Typically, you’ll receive this message 6-8 weeks after your video doctor visit. 
  • 7-8 days after you receive a notice that your PA has been approved, you’ll receive a message from a Calibrate doctor confirming that a prescription has been sent to the pharmacy of your choice. 
  • Lastly, your pharmacy will reach out and let you know that your prescription is ready for pickup.
     

What to do when you’ve gotten your medication

Once you’ve gotten your medication, you should also receive a prompt in your app to record the date when you started taking it. This helps our Medical Team to properly track your progress, so don’t ignore it. If you don’t receive the prompt, let us know via the Support Center in your Calibrate app.

We also recommend that you cross-reference the dose your pharmacy gave you with the dosing instructions that you’ll find in the “Medication and Medical Guides” folder in the Documents section of the Calibrate app. In the unlikely event that there’s a discrepancy between what we prescribed and what your pharmacy delivered, let the Medical Team know in the app. 

After you’ve confirmed you have the right dose, you can start taking your medication right away. For additional tips and side effects strategies, you can always refer to the “Medications and Medical Guides” folder.

Lastly, if you have questions related to taking your medication, possible side effects, and your metabolic health, you can connect with the Medical Team by reaching out through the Calibrate app. 

How metformin may or may not fit into your treatment plan

In some cases, our Medical Team will determine that you’re a candidate for a medication called metformin, which is a safe and effective way to help control your blood sugar. Metformin typically does not require a PA, and in the event there are insurance issues, it’s also very low cost out-of-pocket. You’ll most likely continue to take metformin after you get your GLP-1 medication.  If this isn’t the case, your doctor will let you know during your initial visit. Throughout your time on a GLP-1, metformin can be a helpful additional way to support weight loss and metabolic balance.

What to expect if your coverage is denied 

If we aren’t able to get access to a GLP-1 medication for less than $25 per month (after any deductible has been met) for you within the first ninety days of the program, we will notify you via the Support Center in your Calibrate app. Once notified, you may request a refund and exit the program, or choose to stay in the program covered by our Calibrate Results Money Back Promise. If we do not hear from you within seven days of receiving this notification, we will assume you are choosing to stay in the program and waiving your right to a medication access based refund. Read more about our refund policy here.

How you’ll get future prescriptions

Whenever possible, your Medical Team will prescribe a multi-month supply of your medication, meaning that you can deal directly with your pharmacy for refills each month. Importantly, for the first few months you might see that you have zero refills after each dose. This is only in reference to that dose. The way we titrate you up is to give you one fill on each dose leading up to the dose we want you to stay on the longest—the remainder of your refills will be on that dose. 

If your pharmacy lets you know that you’ve gotten to the end of your refills, please reach out to us via the Support Center.

What to know if you miss a dose of your medication

Your medical safety is always our first priority. While stopping a GLP-1 can cause an increase in hunger, there are no serious side effects associated with stopping GLP-1 medication and there are no withdrawal symptoms—whether you titrate down gradually or stop abruptly. 

If you’ve missed two doses or fewer, your Medical Team will generally start you back on your same dose. If you’ve missed more than two, it’s possible they may recommend restarting at a lower dose to avoid side effects. Keep in mind that the weight you’re losing is the result of the lifestyle changes you’re making as well as your GLP-1s, and the habits we’re helping you build are designed to help you sustain your new, lower weight without medication. So even if you’re off medication for some time, your progress is unlikely to be compromised.

What to do if your insurance coverage changes 

If your insurance coverage changes, reach out to the Support Team. In that message, please provide photos of the front and back of your new insurance card. Unfortunately, new insurance means a new PA process, so it may take some time to get you back on a GLP-1, but as always we will do our very best to support you. 

A note on medication shortages

GLP-1 medications such as Ozempic, Wegovy, and Mounjaro have been periodically in shortage nationwide since 2021, making it difficult for patients to have consistent access to these medications, or to access them for the first time. We understand it can be concerning to have trouble filling a prescription from your doctor.

Calibrate is fundamentally different from prescription-only services. Medication is just one aspect of our program, and at Calibrate, we use medication as a tool—not the entire treatment. The Calibrate program is built to help your body do the same kind of work that medications like Wegovy and Saxenda do, so the best thing you can do if you’re affected by a shortage is to lean into the program. 

If you can’t access your GLP-1 medication because of a shortage, Calibrate will work with you 1:1 to determine appropriate next steps. To ensure continuity of care, this may include changing to a dose that is currently in stock, finding an alternative GLP-1 medication that is covered by your insurance, or tapering off altogether (if clinically indicated). 

For more information on medication shortages—as well as helpful tips for anyone experiencing a gap in medication because of a shortage—check out our landing page here.

A final word

Excited? Nervous? Have more questions? We’re here for all of it. Our teams are here to support you at every step as you move toward better metabolic health. This means aligning you with the right medication, helping you access it, administer it, and answering all your questions along the way. Let’s do this…