#35 Lost Your GLP-1 Insurance Coverage (or Ready to Switch)? Here's What to Do Next.

If your insurance stopped covering Ozempic, Wegovy, or Zepbound — you're not alone, and you're not out of options.

In 2026, the number of people with no commercial insurance coverage for GLP-1 medications increased 42% compared to last year. Dr. Kylie Burton and Jessica Brickie break down why coverage is disappearing, what happens to your body when you're cut off cold turkey, and how to continue your journey safely and affordably — whether you've lost insurance or you've been getting peptides from sources you're not totally sure about.

In this episode:

• Why insurance companies are dropping GLP-1 coverage — and who's really making that call
• What happens physiologically when you stop cold turkey at a high dose
• The gray market problem: why "so-and-so's nurse friend" and research-grade peptides are a dangerous shortcut
• How to switch to a legitimate, prescription-based source without starting over
• How to transition your existing prescription to a telemedicine platform and pick up right where you left off
• Why titrating down to a maintenance dose may be a smarter long-term strategy than stopping entirely
• The PCOS connection: why some people literally cannot make these peptides naturally

Who this episode is for: Anyone on Wegovy, Ozempic, or Zepbound who lost coverage, is sourcing peptides informally, or wants a safer and more affordable path forward. The peptides we recommend require a prescription license. They are prescriptions for a reason. Do them safely. 

Want to connect more with the hosts? We'd love it! Connect with Jess at B2BwithJess.com/peptides or on Instagram @jessb.talkshealth. Grab your Blood Work & Peptides Mini Guide for free at drkylieburton.com. 

Ready to explore peptide therapy for yourself? Visit the company we recommend for pharmaceutical peptides and receive all the one-on-one support that comes included at drkylieburton.com

Want to offer peptide therapy in your business? Whether you're adding it to your existing practice or building something new, learn how to get started—and how we'll mentor you along the way—at drkylieburton.com

Legal Disclaimer: This podcast is for educational and informational purposes only and is not intended as medical advice, diagnosis, or treatment. Always consult with a qualified healthcare provider before starting any new health protocol. Dr. Kylie Burton and Jessica Briecke are affiliates and may receive compensation for referrals. Individual results may vary.

You have the science. You have the tools. Now it's time to take the next step.

This is PepTalk: Peptides Unpacked—science made simple, results made real.

Transcript

Peptides Unpacked Introduction

SPEAKER_00 0:02

Peptides are powerful and often misunderstood. And we're here to change that one conversation at a time. I'm Dr. Kylie Burton. And I'm Jessica Brickie.

SPEAKER_01 0:14

This is Pep Talk. Peptides Unpacked. Science made simple. Results made real.

Why Coverage Keeps Tightening

SPEAKER_00 0:22

So Kylie, over 41 million people currently have no commercial insurance coverage for things like Wagovy and Ozempic, and over 109 million have no coverage for Zetbound. So that's the difference between a GLP one only, a semaglutide, and the trize to the trzepatide that we use, Manjaro and Zetbound. And even for those who have coverage, 88% still have to meet additional requirements like prior authorization. And without insurance, GLP1, like Wagovi and Zetbound, can cost more than a thousand people, used to cost more than a thousand dollars a month. Well, that was for people that are accessing through things like Metaspause. So people are certainly looking for more affordable ways to get them that don't have coverage. But over 40% of privately insured adults, that's more than 57 million people, they're clinically eligible for a GLP1 drug, but only 3% actually had a prescription filled. So out of that 57 million people, only 3% were able to act, well, they either wanted the access or not, but 3% were able to fill a prescription. And nearly two-thirds of patients discontinued treatment before reaching that 12-week mark for meaningful weight loss. That's a whole conversation about our expectations. That's where education really comes, which they're not getting in their doctor's offices. But in 2026, the number of people with no commercial insurance coverage for things like Wakovi increased by 42% compared to 2025. So nearly half of those people that were getting coverage through their insurance are no longer getting coverage, which was something in a recent expo I did with conversations I was having all the time. The GLP1 drug cost represented an average of 10.5% total annual insurance claims in 2024. That was up from 6.9 in 22. So it's gone up. What a lot of people, 30% of employees say that they're at least somewhat likely to remove GLP 1 coverage in the next few years if prices stay where they are. Okay. So let's talk about all of these things. Number one, because of the increased demand, price is coming down. But healthcare is a business. Insurance is a business. Drug companies are a business. So if it's not profitable, they're going to make it more difficult. Then there's the side of the people that did get coverage that we're going to talk about today that were suddenly dropped because their blood sugar is in check. They've lost weight, so their BMI is no longer a problem. And all of a sudden they went from being on this GLP one and maybe they were at a top titration, a top amount, and suddenly the rug was pulled out from underneath them and they no longer have coverage. That's a problem. To me, that's irresponsible healthcare. There should be a comeback down to maintenance option, not just make sure we're understanding what you're saying.

SPEAKER_01 3:32

People who have been on Agobi, Zbound, Ozempic, the name brands, they once they hit a certain BMI, their insurance drops them. Correct. And now we're getting told, oh, well, if you go on these drugs, you're gonna gain your weight back.

SPEAKER_00 3:55

There's so much to unpack here in that one sentence.

SPEAKER_01 3:59

Let's unpack it. Why not? First, let's start with those of you who have been on an insurance-based peptide, an insurance-based prescription. And you hit a BMI where they're saying we're no longer going to cover this, which means you probably stopped taking it and then got your weight back. Just there's alternatives for this. There's a better way to do it. Let's walk them through what that looks like.

Why Weight Comes Back

Gray Market Risks Explained

SPEAKER_00 4:28

Okay, so first I want to say anytime I just this is something we say in every episode when we're talking about this. Um, the foundations to your wellness always will matter. So if you were on these and you were not changing how you were managing stress, how you were sleeping, and how you were nourishing your body both with food and with the information coming to you, all of that's gonna impact your your success post-GLP one use because not everybody needs to be on them forever. However, if you were at a titration, a high amount and suddenly just stopped, your body has now gone into this holy crap, what's happening? It's in a panic, it's under stress, and many of those things that you were working to resolve that got you there, even if you're eating right, I heard repeatedly from people they were they had changed their tools and they gained weight back. Didn't happen overnight, but eventually they did. Why? Because they went from their body feeling safe and secure and having these peptides in their body, and instead of gently coming back down to a lower amount, suddenly it was gone from their body. The body panicked. The food noise started to return, they slipped back into old comfort eating habits. Maybe they didn't have the energy that they were having because things are very dysregulated now. Um, the easy the thing is that people don't know that they can get them from other places. Now, at the at the place you and I just did this expo where we were forward, we were out there with the end user, we were out there with the patients that were out there using these tools. And they didn't know that there were sources that they could get peptide safely from because they're like, I'm not doing research grade, I'm not doing the gray. I mean, I was impressed that people even knew what the gray market is. And for those of you that are listening that don't know what the gray market is, that is a place where you can you are getting sourcing research grade peptides that say not for human consumption. Are there some companies that might be a little bit more reputable than others? Yes, but largely it's like the wild, wild west out there. And I have seen people get serious infections, they're misdosed, there's no oversight. So people are out there putting these, these are prescriptions, these are serious things to put in your body without anybody looking at blood work, without anybody having any idea if there's any contraindications because maybe they have this going on or they're taking in another medication.

SPEAKER_01 7:02

That's why the term research grade, that's why it exists. Right because they're bypassing the need to get a prescription for these and calling them research grade.

SPEAKER_00 7:15

They're also bypassing the need to do things like what we do with our telemedicine company, which is triple purifying, third-party testing, making sure these are safe for human consumption, for the body, that they're going to do what they say high quality FDA improved ingredients. We are in a good spot. But but there are people that are out there that know that that's not what they want, right? So that's the gray market. You don't want anything to do with it. It's a dangerous game to play with your body. So they know they don't want that, but they also don't know where they can go safely. They're overwhelmed. They're seeing advertising.

SPEAKER_01 7:57

Because the people who I talked to over the weekend at the expo, now remember, guys, we were at different expos. She's at an expo on the East Coast, I'm here at an expo in Utah. And we wanted to bring these to the forefront of people to just see what you know, general public as they walked through the doors, what was happening, what were the conversations we were gonna have. And one of them, one of the many conversations I had was if people were taking them, they were getting them from so-and-so's nurse friend, so-and-so's friend out of Mexico, so-and-so knows a pharmacist. It was always so-and-so this, and I'm like, you're wanting to do the best things for your body, but you're willing to just inject any substance so-and-so's friend so-and-so this gave you, there's a better way to do this and a better way to access this, and we need to open up the conversation to these because it's not just bringing people in from insurance, but bringing people in from who are doing these and getting these in a way that that's probably not standard A-level peptides, right? Might be B, C, or D grade peptides. So, if you're gonna do what your body wants and be the do the best things for your body, get the best stuff.

SPEAKER_00 9:21

So, I think going back to the insurance question, too, um, a couple of things. One, very often this is an employer, employer choice whether or not they're gonna cover certain trucks. Okay, so just don't get mad at the insurance company all the time. It's not always the insurance company making this decision. It could be the employer plan. It could also be the insurance company, right? But if you're not getting coverage, don't lose hope that this isn't for you. Yes, that does mean some money out of pocket. But in my case, I was like, okay, so it's one less trip to TJ Maxx. If we are relying 100% to only see the doctors that are in our network, that only get the medicine that's on our prescription plan, we are probably shutting ourselves out from an opportunity to truly heal our body and feel our best and do our best. And unfortunately, the insurance company, in my opinion, this is just my opinion, but the insurance company, the drug companies, and a lot of these medical conglomerates are really about the bottom line and not as much as they say patient care as they claim. So we can put people into a position that can get these affordably. Now, true, two years ago to get these, if we're gonna talk just about GLPs, there's so many other peptides, but if we're gonna talk about GLP one, because it is the one that people are most familiar with and probably wanting the most right now. You could go to a med spa if you weren't covered, but you were only a certain category of person that could afford that because you were talking$1,200 to$1,500 per month that people were paying to get these drugs, which is ludicrous, right? Like that's just bananas, and the average person can't do that. That is not what the cost is, that is not what the market is doing anymore. They are much, much, much more affordable than they used to be. So if you don't have insurance company, you're not out of the game. If your insurance company dropped you suddenly, you're also not out of the game. We are out here trying to educate people that there is another way, another safe way to still stay on them. I'm sure you heard this too over the weekend. I never felt better than I did when I was doing that.

SPEAKER_01 11:38

Well, I had some amazing stories. I got connections, so I'm hoping we can bring them on to as guests.

Titrating Down And Maintenance Thinking

SPEAKER_00 11:45

There was um a friend of ours that recently shared something, I think it was last night or this morning, and I shared it on my Instagram, that those that have PCOS, it's a metabolic dysfunction. So we know for many years the medical community has treated endometriosis PCOS with a drug called metformin. Horrible, horrible, horrible drug. Does it help you balance blood sugar? Sure. Does it wreak havoc on your intestinal, your digestive tract? Yes, it does. It's awful. People feel like garbage on it because we know that with PCOS, there is a direct link to that, right? Now we know that there's a metabolic, there's something that has been missing. The people are not making these GLP ones, these GIPs. So people are looking at these drugs for approval just for weight loss. They're looking for their insurance company to approve them just for blood sugar dysfunction. But in the case of PCOS, where the body is literally not making these peptides that we normally make, there's another case, hopefully, that maybe they would get insurance company coverage, but likely not. They're likely not going to still get coverage for that reason, even though we know the science is out there. It was a Swedish study that was just published. We know that they're not making it in their body. So, insurance company or not, there are other ways that you can get that. Don't just suddenly stop, though. If you are on insurance and you your insurance company stops covering them, find another way. Talk to us. Let's figure out a way to. We are the other way. We are the other way. Come join us. Affordable other way. Um, but to see these numbers that in 2026, just to say this again, people with no commercial insurance coverage for these, the number of people that have no, could let me say that again, no commercial coverage increased by 42% compared to last year, 2025. 42%. I just had a person that came to me who works for an insurance company, big one, big, one of the big ones, one of the old old insurance companies. She is an employee, she helps people. This is her job is to approve or disprove claims. She knows her way around insurance, and she's been fighting her own employer to get coverage for something. Let me tell you, she is more than qualified for multiple reasons to get these, and she cannot get them. From her own insurance company, she is an employee of an insurance company and she cannot get them. It's crazy. 42% of people no longer can get them that were getting them last year.

SPEAKER_01 14:29

All right, so let's walk them through how how can they do that? If if they've been on it, they lost the weight, and they want to go back on it in a safe dose. Now let's talk. We're not going to talk specific doses here because we legally can't. We also legally can't talk about our income claims. Like we can't do that. Um, so they're taking it, you know, let's just say a standard of 10. Vogel, was empic, the things that's at a level 10. Some people are taking a little uh more than that, but that's pretty standard, is 10. So they go, they take this, they get the work gone, they're at the BMI that their doctor wants to see them at, their insurance says, okay, you're no longer worthy of this. They take it from them, but they bend at a 10. Just like if you were to titrate up, we want to titrate down and get off to a maintenance. So I had this discussion with an individual over at the expo, and I we walked through kind of what their dosage looked like and what did this long-term plan look like? Because we've all heard the stories. Well, if you get off of it, you gain the weight back. What if you get off of it correctly by titrating down? And then what if you stay on a tiny, tiny dose that you might need once a week, maybe once a month, or you know, maybe you don't need them at all. But I would hope that if you've been through a lot of our episodes, you'll understand that there's way more to GLPs than just weight loss, and you'll be like, I want all of the other benefits from it. So I'm gonna take a minor maintenance dose for a long-term timeline, and we'll see what that long term looks like: a year, two years, five years, it's totally up to you. But there's a way to titrate down off of these correctly if you want to go off. There's also a a new way to think about this as a maintenance, as a just tiny, tiny dose once a month.

How To Transition Via Telemedicine

SPEAKER_00 16:31

So I think everybody's gonna be a little bit different here. And if I had a crystal ball for that person coming to me and say, I want this, but do I need to be on this for the rest of my life? I don't know. So let's just put that out there. I don't know. I don't know if you need to tie trait down. I don't know if you need to stay at that 10 that Kylie just mentioned. Everybody's future path is going to be a little bit different. That's the beauty of working with us and having a provider. You can have that relationship. But to your point, and I think the question really it was, what do you do? So if you are currently on a prescription and you suddenly get cut off by your insurance, you just need to take that prescription that you got from your doctor, whoever was writing that prescription that you're getting through insurance, and you're going to upload that with the telemedicine platform that we work with so that you can easily transition to that same amount. So if you're not done with your journey, let's let's say your BMI came down to like 27, okay, which that is for some insurance company, that's the cutoff point, 27. But that is still a high BMI. We still would like to see you down in the low 20s, more like you know, 20 to 22. That would be great if we could get you down there. If you're 25 still, 27 still, your BMI is still high, you still have excess body fat, you still have a journey to go, regardless of where you're at. You take that prescription, you bring it into this telemedicine platform, you upload it, and that's the conversation you have with our provider. Where do you begin for your dosing? So whether you're going to continue with where you're at, come back down, switch over to a microdose plan. There's multiple ways to do that, but you bring your prescription with you, you easily upload it and you can continue your journey. Insurance cutting you off doesn't have to be the end, nor should it be the end of your journey. I wish it wasn't this way. I wish we weren't having to have this conversation. I wish that people had more access than they do. But at the end of the day, unfortunately, healthcare is a business, and they're looking to make sure that that is still a successful business model for the insurance company, for the healthcare conglomerate that we've talked about, because many of them are not small practices, and for the pharmaceutical company, they want it to be a successful business venture for all of them. So they're going to look at the bottom line, not necessarily the best patient care. And that's the unfortunate truth.

Where To Find Us

SPEAKER_01 18:54

Yeah. And if you are somebody who's been on these and you don't have a prescription, well, let's start doing them the right way and get you a prescription utilizing our telemedicine platform. So, Jess, where can they find you?

SPEAKER_00 19:09

Yep. So if you want to, you can come on board with me and you can get your peptides on my website through me, b2bewithjess.com. You can also follow me on Instagram, which is jessbe.toxhealth. I talk a lot about what's going on in the peptide world, drop lots of tidbits of education. Um, and obviously you can message me there too. So you can get me in lots of ways.

SPEAKER_01 19:32

If you are looking at adding this on to yourself as a business, whether it be a side hustle, whether it be an additional income stream, whatever that might look like for you, and you're interested in joining us now as we move to the forefront and as these become well known over the next five years, you're gonna want to be in on this. Go to drkylieburton.com to join us as an affiliate or to order your peptides as well. And if you haven't seen, I have a new platform. You can find that at protocol.drKlyburton.com where you can utilize your labs and a questionnaire and get your peptide solution personalized. So that's once again protocol.drKylie Burton.com. And we will see you on the inside of our team if you join us as an affiliate or on the inside if you're ordering your peptides through our telemedicine company in a safe manner with safe prescriptions and a safe sourcing, which we highly recommend wherever you're getting them from. Let's do this the right way, let's do it this the safe way. And uh we'll keep informing you, we'll keep providing you stories. This is pep talk, peptides unpacked.