Although not available for purchase yet, Retatrutide for obesity and weight loss might be the most effective medication of all available when it is launched. Similar to other highly effective diabetes and obesity medications, it will likely be expensive. This page discusses Retatrutide, who it is for, how it is administered, and more.
What is Retatrutide?
Similar to Ozempic, Wegovy, Mounjaro and Zepbound, Retatrutide is a medication for diabetes and obesity. From Eli Lilly, also the manufacturer of Mounjaro and Zepbound, Retatrutide is a GLP-1 (glucagon-like peptide-1) receptor agonist that also works on the hormones GIP (glucose-dependent insulinotropic polypeptide) and glucogen. In response to food, GLP-1 releases insulin, slows gastric emptying, inhibits glucogen, promotes satiety so you have less of an appetite, and may reduce the risk of stroke and cardiovascular disease. GIP stimulates the release of insulin, inhibits the release of glucogen, and, among other things, helps to manage blood sugar and metabolism. Finally, glucogen has the opposite effect of insulin, promotes the release of glucose from your liver, and raises blood sugar levels. Together, these hormones help regulate both metabolism and blood sugar.
A denial for Retatrutide doesn’t automatically mean your insurer is right.
Because Retatrutide is a newer medication, insurance companies often deny coverage by labeling it as “experimental,” “not covered,” or outside their formulary.
But those decisions are not always based on your individual medical needs or your doctor’s recommendation.
In some cases, the denial can be challenged — especially when there is strong medical support for why this treatment is appropriate for you.
What is Obesity?
Obesity is a chronic condition characterized by the excessive buildup of body fat leading to an unhealthy body weight. This condition heightens the risk of various health issues including heart disease, type 2 diabetes, sleep apnea, and certain forms of cancer. Obesity is calculated by BMI, or Body Mass Index. To determine BMI, you divide a person’s weight in kilograms by the square of their height in meters. Obese is defined as a BMI equal to or greater than 30. (Overweight is defined as a BMI between 25 and 30.)
Several Americans are overweight or obese. In fact, nearly 31% of American adults are overweight while 42% are obese. (It’s estimated that nearly 50% of these adults will be obese by the year 2030.) Nearly 20% of kids 2 to 19 are obese. A study published in March 2023 evaluating 20 – 44 year olds from 2009 to 2020 discovered the prevalence of diabetes grew from 3% to 4.1% and the incidence of obesity increased from 32.7% to 40.9%.
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How is Retatrutide Administered?
Similar to Wegovy, Ozempic, Mounjaro and Zepbound, Retatrutide is given via a weekly injection under the skin.
Who Can Take Retatrutide?
The population will be determined by the FDA when the drug is approved. That said, clinical studies included individuals with type 2 diabetes and both overweight and obese people (depending on the specific clinical trial). It’s likely that Retatrutide will be approved for type 2 diabetics, and people with a BMI of 30+ (obese) and those with a BMI of 27+ (overweight) with weight-related issues.
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Is Retatrutide More Effective For Weight Loss Than Wegovy, Mounjaro, Zepbound and Ozempic?
The New England Journal of Medicine published results from a Retatrutide Phase 2 clinical trial in June 2023. In this study, Retatrutide outperformed Wegovy and Mounjaro (same formula as Zepbound) in terms of both weight loss and time to lose this weight. (Wegovy already outperforms Ozempic at higher dosage levels.) The study included individuals who weren’t diabetics and who had either a BMI of 30+, or a BMI of 27 to <30+ and at least one weight-related health condition. Eli Lilly, maker of Retatrutide, tested various injection doses including 1 mg, 2 mg, 4 mg, 8 mg and/or 12 mg. The study looked at the percent body weight change from baseline to both 24 and 48 weeks. It also reviewed weight loss of 5% or more, 10% or more, and 15% or more at 48 weeks.
As expected, the higher the dose, the more weight an individual lost. And the longer a person remained on the medication, the greater their weight loss. So, at 48 weeks, individuals on the largest dose of 12 mg lost nearly 58 pounds or an average of 24.2% of their body weight. And in terms of time to lose weight, 48 week results were superior to Mounjaro, Zepbound and Wegovy. Mounjaro/Zepbound (tirzepatide) participants lost an average of 22.5% (52 pounds) of their body weight after 72 weeks. And, as noted above, Wegovy (semaglutide) study participants lost an average of 15% (34 pounds) of their body weight after 68 weeks.
And at 48 weeks, of those given 4mg, 92% of Retatrutide participants lost 5% or more, 75% of these people lost 10% or more, and 60% of them lost 15% or more. At 48 weeks, of people given 8 mg, 100% lost 5%+, 91% lost 10%+, and 75% lost 15%+. Also at 48 weeks, of individuals who took 12 mg, 100% lost 5% or more, 93% lost 10% or more, and 83% lost 15% of more. In the placebo group at 48 weeks, 27% lost 5%+, 9% lost 10%+, and 2% lost 15%+.
Will Insurance Companies Cover Retatrutide?
Of course like similar GLP-1 medications, health insurance coverage will vary by specific insurance company. ACA (Affordable Care Act) plans aren’t required to cover weight loss medications or obesity-related surgeries. That said, many of them do cover these medications. In fact, an August and September 2023 poll of employers with self-funded plans found that 25% of them cover weight loss medications today and that this number is expected to grow to 43% in 2024. Also, in California, the Department of Managed Healthcare overturned several insurer denials of Wegovy in external appeals in 2023. The Veterans Administration covers some medications for obesity. Medicaid coverage varies state to state. Medicare doesn’t cover weight loss medications, but certain Medigap and Medicare Advantage plans for retired individuals do cover Wegovy.
As more people take GLP-1 medications like Retatrutide and achieve positive results, it is possible that Medicare might cover this drug for obesity in the future. Why? Because obesity causes many other health problems and thus increases medical costs. In fact, it’s estimated that Medicare might save $176 billion over ten years due to fewer surgeries, hospitalizations, physician visits and other medical procedures. Savings to Medicare could reach $700 billion by 30 years. And in states like California, there have been multiple instances in which independent medical reviews overturned health insurer obesity medication denials.
In terms of private health insurance plans, coverage differs among major commercial insurance companies such as Anthem Blue Cross, Kaiser, Cigna, Blue Shield, UnitedHealthcare, Aetna, Oscar, and Health Net. And of course their coverage is based on multiple factors including the specific insurance policy, medical necessity determination, and individual health circumstances. Commercial health insurance companies typically approve claims when they deem them medically necessary. That said, gaining approval can be difficult even when many other alternatives have already failed.
Can My Doctor Prescribe Retatrutide Now?
Retatrutide prescriptions likely won’t be available prior to 2025 to 2027 because the medication is being studied in a Phase 3 clinical trial that won’t end until 2025 or 2026.
Can I Find Retatrutide Now?
Even though it is still in clinical trials and has not yet been FDA-approved, there are online sellers of counterfeit Retatrutide. Much of this fake product appears to be shipping directly to the United States from China. Counterfeit medications are not monitored like FDA-approved drugs and can lead to health issues. In fact, in October 2023, several individuals in Austria used fake Ozempic, another GLP-1 medication, and ended up in the hospital.
Denied Coverage for Retatrutide? Let’s Build a Strategy to Challenge It.
When an insurer refuses to cover a newer medication like Retatrutide, it can leave you stuck between your doctor’s recommendation and the insurance company’s rules.
We can review your denial, your policy, and the medical support behind your prescription to determine whether the insurer’s decision can be challenged — and what approach gives you the best chance of approval.
Do not assume the denial is final.
Get clarity on your options and take the next step with confidence.
Law Offices of Scott Glovsky
For nearly 25 years, the Law Offices of Scott Glovsky has been aiding individuals who have suffered injuries or been subjected to unjust business practices. With a focus on health insurance bad faith, catastrophic personal injury, sexual abuse, and consumer-related legal issues, we get justice for our clients and hold those responsible liable for their actions.
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