Semaglutide, sold as Ozempic for Type 2 diabetes and Wegovy for chronic weight management, is probably the most talked-about medication of the past several years. Patients arrive at Dr. Maryam Khan’s primary care practice in Lutherville-Timonium, MD having read about it, seen it discussed by celebrities or on social media, and with a clear question in mind: ‘Can I get this medication?’
The honest answer is: it depends. And the way to find out whether it depends in your favor, whether you are an appropriate candidate, whether the benefits outweigh the risks in your specific situation, whether insurance will cover it, and whether you are prepared for what it actually involves, is a proper medical evaluation. This article explains what that evaluation involves and what patients need to know before starting this conversation.
Ozempic vs Wegovy: The Same Drug, Different Doses and Approvals
Ozempic (semaglutide 0.5 mg, 1 mg, and 2 mg weekly injections) was approved by the FDA in 2017 for the treatment of Type 2 diabetes and cardiovascular risk reduction in diabetic patients. It lowers blood glucose and, as a side effect, typically produces weight loss of 5 to 10%.
Wegovy (semaglutide 2.4 mg weekly injection) was approved in 2021 specifically for chronic weight management in adults with obesity (BMI ≥30) or overweight (BMI ≥27) with at least one weight-related health condition such as hypertension, Type 2 diabetes, or dyslipidemia. At this higher dose, the weight loss effect is substantially greater: the STEP 1 trial showed an average of 15% body weight reduction over 68 weeks.
Tirzepatide (Mounjaro for diabetes, Zepbound for obesity) is a related but distinct medication that activates both GLP-1 and GIP receptors, producing even greater average weight loss (20 to 22% in clinical trials) and is an option Dr. Khan also evaluates for appropriate patients.
| Using Ozempic ‘off-label’ for weight loss (prescribing the diabetes-approved dose for patients who don’t have diabetes) is practiced but has implications for insurance coverage, dosing, and supply. The appropriate conversation is with a physician who understands the full clinical and insurance landscape, not an online prescribing service. |
Who These Medications Are Designed For
FDA approval criteria for Wegovy and Zepbound require:
• BMI of 30 or higher (obesity), OR
• BMI of 27 or higher (overweight) plus at least one weight-related health condition: Type 2 diabetes, hypertension, dyslipidemia, obstructive sleep apnea, or cardiovascular disease
However, FDA approval criteria describe the population in which the drug was studied and approved, not an automatic prescription for everyone who meets those criteria. Dr. Khan’s evaluation goes further to assess whether the medication is appropriate given the individual patient’s complete medical history.
Who Should Not Use These Medications
GLP-1 medications are contraindicated or used with significant caution in:
• Patients with a personal or family history of medullary thyroid carcinoma or Multiple Endocrine Neoplasia type 2 (MEN2), this is a contraindication, not a caution
• Patients with active or recent pancreatitis
• Patients with severe gastrointestinal disorders (gastroparesis, severe inflammatory bowel disease)
• Pregnancy and breastfeeding, these medications should be discontinued before conception
• Patients with significant kidney impairment (varies by specific medication)
Patients with a history of gallstones or gallbladder disease warrant discussion , GLP-1 medications are associated with a modest increased risk of gallbladder-related events. Patients with a history of eating disorders also warrant careful evaluation before starting appetite-suppressing medications.
What to Realistically Expect
Effectiveness
The clinical trial results are the most impressive produced by any anti-obesity medication to date. Average weight loss of 15 to 22% of body weight represents a genuine clinical breakthrough. However, response varies: some patients lose substantially more, some substantially less. Approximately 7 to 12% of patients in trials did not achieve at least 5% weight loss, making them ‘non-responders.’
Side effects
The most common side effects are gastrointestinal: nausea, vomiting, diarrhea, constipation, and ‘food noise reduction’ (a decreased preoccupation with food that most patients experience as a benefit). These side effects are most prominent during dose escalation and typically diminish over weeks to months. Starting at a low dose and escalating gradually, which Dr. Khan does systematically, significantly reduces their severity.
Muscle mass loss accompanies rapid weight loss on these medications. Dr. Khan emphasizes adequate protein intake and resistance exercise alongside pharmacotherapy to preserve lean muscle mass, which affects metabolic rate and functional capacity.
Duration of treatment
GLP-1 medications are not intended as short-term interventions. Research shows that stopping the medication typically leads to regaining most of the lost weight over 12 to 18 months. For most patients, this is a long-term or indefinite treatment, analogous to taking a blood pressure medication for a chronic condition.
The Insurance and Cost Reality
Cost and coverage are significant real-world barriers. Wegovy and Zepbound list prices exceed $1,000 per month without insurance coverage. Coverage varies dramatically:
• Commercial insurance: Coverage for obesity medications is improving but inconsistent. Many plans require prior authorization with documentation of BMI, comorbidities, and prior treatment attempts.
• Medicare: Currently does not cover weight loss medications, though the TREAT and GLWB Acts have been introduced to change this. Patients on Medicare should specifically ask about this.
• Medicaid: Coverage varies by state. Maryland Medicaid coverage for these medications should be confirmed directly.
Manufacturer savings programs (Novo Nordisk’s NovoCare, Eli Lilly’s savings card) may reduce out-of-pocket costs for eligible commercially insured patients. Dr. Khan’s team assists patients in navigating coverage and prior authorization.
Why Starting This Conversation With Your Primary Care Doctor Matters
Online prescribing services for GLP-1 medications have proliferated. While they have increased access for some patients, they typically provide less comprehensive evaluation, less monitoring, and less support for managing side effects or addressing the broader metabolic health picture. A primary care physician who knows the patient’s full medical history is better positioned to make an appropriate prescribing decision, monitor for complications, and integrate weight management into overall health care.
| To discuss GLP-1 medication options or a comprehensive weight management evaluation with Dr. Maryam Khan, MD in Timonium, MD, call (443) 577-4010. Located at 1205 York Rd, Suite 11, Lutherville-Timonium, MD 21093. Accepting new patients in Baltimore County. |