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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 when starting GLP-1/combined GLP-1 medications. 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 4-6 weeks after your Calibrate clinician appointment to get approved for your medication, but in some cases, it can take up to 8 weeks depending on case complexity.
  • Medication is a tool—not the entire treatment—which is why we don’t guarantee access to medication. If we’re unable to secure initial access to a GLP-1 medication, you can continue in our program without medication or cancel once your 3-month commitment is complete.
  • Regardless of medication access, we guarantee results. If you have not yet reached 10% weight loss at 12 months, get 50% of your program cost refunded as part of our Results Money Back Promise (see terms). 

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 during your time with Calibrate.

The Clinical Team is responsible for evaluating your health, determining the appropriateness of medication, managing your medication dose and any side effects, and helping you taper down your GLP-1 medication when appropriate.

The Benefits Navigation Team handles insurance coverage, works with external pharmacies, monitors nationwide GLP-1 medication inventory, and helps you receive your medication as quickly as possible. Plus, they’re the team who will review your insurance coverage—partnering with your Clinical Team for additional information your insurance company may need and submitting prior authorizations (more on that below). Note: Calibrate is not a pharmacy, and we don’t receive any compensation for 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 during your time with Calibrate.

How you’ll get your GLP-1 medication 

When you meet with your Calibrate clinician for your video visit, they will review which GLP-1 medications are clinically appropriate based upon your individual health history. If you are clinically cleared to start a GLP-1, then the Benefits Navigation Team will investigate your insurance coverage.

The Benefits 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 4-6 weeks after your Calibrate clinician appointment to get approved for your medication, in some cases it can take up to 8 weeks depending on case complexity.

If a PA is approved (or if it’s been determined that a PA is unnecessary), your Calibrate Clinical Team will send your prescription to your pharmacy. Be aware that the name of the clinician on your prescription may not be the same as the clinician you saw during your appointment. 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 

There are a few different variables that may impact your medication costs that are important to know. First, there are various types of coupons in the market. Some come out when new medications reach the market and are often available for a limited time. Others are standard practice and are always available. If a coupon is available for your medication, coupon terms and conditions require that you download the information yourself from the manufacturer’s website and share it directly with your pharmacy to help reduce the cost of your medication’s copay.

Additionally, the cost of your medication is determined by your insurance. If your copay is higher than expected, there may be a few reasons why this is the case. If you have an insurance plan with a deductible that has not yet been met, this can impact your medication cost. If this is the case, you’ll likely have to pay through your deductible before your cost is lowered. Also, GLP-1 medications are often a higher-tier medication on your health plan’s formulary, therefore a higher cost. Lastly, in some cases your insurance plan may require you to pay 100% of the cost of your medication, which means they will not contribute to the cost of your medication and the cost of your medication will not contribute to any deductible. If this is the case, our Benefits Navigation Team will do further research to help find an alternative option for you covered by insurance.

Communication 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 from Calibrate—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 clinician visit, you’ll receive a message from a Calibrate clinician.
  • The next update you’ll receive will be once your PA has been approved. You may hear this message directly from your Pharmacy Benefits Manager (PBM) or your insurance plan as a letter or email. Typically, you’ll receive this message 4-6 weeks after your video clinician visit.
  • 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 receive a prompt in your app to record the date when you started taking it. This helps our Clinical 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.

It is very important that you cross-reference each dose your pharmacy gives you with the dosing instructions that you’ll receive in your after-visit summary. You can also access dosing information for your specific medication here, as well as in the “Medication Guides” folder in the Program Resources section of the Calibrate app. If there is a discrepancy between your dosing schedule and what your pharmacy dispensed, please DO NOT begin taking your medication. Instead, reach out to the Clinical Team in the app.

After you’ve confirmed you have the right dose, you can start taking your medication right away unless our Clinical Team has recommended otherwise. For additional tips and side effects strategies, you can always visit our Medication Information page, or refer to the “Medication Guides” folder in the Program Resources section of the Calibrate app.

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

What to expect if your coverage is denied 

Medication is a tool—not the entire treatment—which is why we don’t guarantee access to medication. If we’re unable to secure initial access to a GLP-1 medication, you can continue in our program without medication or cancel once your 3-month commitment is complete. Regardless of medication access, we guarantee results. If you have not yet reached 10% weight loss at 12 months, get 50% of your program cost refunded as part of our Results Money Back Promise (see terms).

How metformin may or may not fit into your treatment plan

In some cases, our Clinical Team will determine that you’re a candidate for a medication called metformin, which can be helpful for members with type 2 diabetes, prediabetes, insulin resistance, PCOS, and other metabolic conditions. Metformin is a safe, inexpensive medication and can be an additional way to support your metabolic health. Metformin is a generic medication that typically does not require a PA, and in the event there are insurance issues, it’s also very low cost out-of-pocket. Our Benefits Navigation Team will not complete PAs for metformin.

You can start metformin once received and should continue to take metformin after you get your GLP-1 medication unless otherwise instructed by the Calibrate Clinical Team.

How you’ll get future prescriptions

After your initial medication approval, your Clinical Team will prescribe medications in three-month intervals. Importantly, for the first few months you might see that you have zero refills for each dose. This is because most GLP-1 medications require a titration in which you increase the dose monthly (or weekly depending on medication brand). We prescribe one fill (no refills) on each titration dose and will provide additional refills once you’ve reached your maintenance dose. If during the titration period you prefer to slow it down or hold at a specific dose, please reach out to the Clinical Team via the app. 

Every three months, you will receive a check-in from our Clinical Team. This check-in is required  in order to receive prescription refills so please address it in a timely manner. This information helps us to ensure your dosing is still medically appropriate and to help handle any side effects you may be experiencing. If at any time you decide not to continue your participation with Calibrate, our Clinical Team will not be able to provide ongoing medication management and any refills on file at your pharmacy will be canceled.

If your pharmacy lets you know that you’ve gotten to the end of your refills, please reach out to us directly in the Support Center to request additional refills. We are unable to accommodate requests directly from your pharmacy. 

What to know if you miss a dose of your medication

Your clinical safety is always our first priority. While stopping a GLP-1 can cause an increase in hunger, it is safe to stop a GLP-1 medication abruptly without a taper down when taken for obesity/overweight management. If taking a GLP-1 medication for diabetes or other clinical reasons, please alert your provider before stopping your medication.

Please reach out to the Clinical Team before restarting your medication after a missed dose, especially if you’ve missed more than two doses as you may need to restart at a lower dose to reduce the risk of side effects. If you’ve missed less than two doses of GLP-1 medication, your Clinical Team will generally start you back on your same dose.

Keep in mind that the weight you’re losing is the result of the lifestyle changes you’re making as well as the medication, and the habits we’re helping you build are designed to help you sustain your new, lower weight on the lowest effective dose of medication, or even without it! 

What to do if your insurance coverage changes 

If your insurance coverage changes, reach out to the Support Team in the Calibrate app. In that message, please provide photos of the front and back of your new health insurance card. If you have a separate card for your pharmacy benefits, please include photos of the front and back of that card too. Additionally, please confirm the current dose of medication you’re taking along with the date of your last dose.

Unfortunately, new insurance means a new PA process, so it may take some time to get you back on a GLP-1 medication, but as always, we will do our very best to support you. Please note, while your insurance coverage changes may impact your access to your prescription, it is safe to stop a GLP-1 medication abruptly without a taper down when taken for obesity/overweight management. Your safety is always our first priority so please reach out to the Clinical Team in the Support Center if you’ve missed more than two doses during this time as you may need to restart on a lower dose to reduce the risk of side effects. 

A note on medication shortages

GLP-1 medications have been periodically in shortage nationwide since 2021, making it difficult for people 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 clinician.

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 GLP-1 medications do, so the best thing you can do if you’re affected by a shortage is to lean into the lifestyle aspects of the program.

If you can’t access your GLP-1 medication because of a shortage, Calibrate will work with you 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 stopping medication use 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 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, weight loss, and lasting results. 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!