Foundayo Weight Loss Pill at Form Health

If you miss a dose of Foundayo™, take it as soon as possible. Do not take 2 doses of Foundayo on the same day. Do not take more than 1 tablet per day. If you miss taking Foundayo for 7 or more days in a row, call your prescribing clinician to talk about how to restart your treatment. 

You may notice the effect of Foundayo including decreased hunger signals as soon as you start taking it, but this will vary from person to person, with some individuals needing a higher dose to experience its effects.

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You’ll take the starting dose of 0.8 mg for at least 30 days. The dose of the medication can be increased monthly up to a maximum of 17.2 mg daily. You will stay on a dose for a minimum of 30 days to give your body time to adjust and reduce the risk of severe side effects. Your clinician will work with you to determine what dose is right for you based on response and tolerability.

Foundayo received FDA-approval for chronic weight management, which means it is intended for long-term use as part of an ongoing treatment plan. It’s meant to help adults with obesity, or adults with overweight and at least one weight-related medical condition, reduce excess body weight and maintain weight loss over time when used with a reduced-calorie diet and increased physical activity.

Foundayo can make some people feel tired, and fatigue is listed as a potential side effect of the medication. It is not the most common effect for everyone, but it has been reported as one of the possible symptoms people may notice while taking it.

Drinking alcohol is generally not recommended when patients are taking Foundayo. Foundayo is intended for use in combination with a low-calorie eating pattern, and drinking alcohol can make it difficult to achieve a caloric reduction. Alcohol is not a calorie-free beverage, and by lowering inhibitions, it can lead to increased food consumption. It is important that you discuss your alcohol intake when taking Foundayo with your provider, as it may be advised to avoid alcohol completely.

The best way to find out if Foundayo is covered by insurance is to call the number on the back of your insurance card to learn more about your cost and coverage for a Foundayo prescription under your plan. In addition, most insurance companies provide a drug formulary online, which is a list of all medications covered by insurance and what criteria needs to be met in order to be covered.

A Foundayo prior authorization is paperwork requested by your insurance carrier to justify the use of Foundayo. Some insurance plans will require prior authorization paperwork to be completed in order to cover the cost of Foundayo. Your healthcare provider will complete the paperwork for Foundayo prior authorization. Unfortunately, this is not a guarantee of insurance coverage for Foundayo. Your Form Health Care Team can assist with prior authorizations.

Keep in mind that coverage and costs vary based on your specific insurance plan. To learn more about your exact costs for Foundayo or other medications, contact your insurance company using the phone number on the back of your insurance card.

To lower your out-of-pocket cost for Foundayo, Foundayo manufacturer Eli Lilly offers two options. If you have coverage under your insurance plan, you can take a Foundayo coupon savings card to your local pharmacy to pay as little as $25 per month out-of-pocket for your medication. They also offer a self-pay option via LillyDirect for those without coverage that starts at $149 per month. 

Keep in mind that coverage and costs vary based on your specific insurance plan. To learn more about your exact costs for Foundayo or other medications, contact your insurance company using the phone number on the back of your insurance card.

Foundayo's price can be difficult to afford without insurance coverage; it is expensive out of pocket. Additionally, insurance cost and coverage can vary. Contact your insurance company using the phone number on the back of your insurance card to see if this medication is covered, if a prior authorization will be needed, and learn more about your costs. If Foundayo’s prescription cost is not covered, your Form Health medical provider can help you find an alternative medication that may be right for you.

Some people choose to get compounded semaglutide medication instead of the brand name medication like Foundayo. Although they are often available at a lower cost, it’s important to know that these compounded weight loss medications come with real risks. The molecule has not been tested in clinical trials or approved by the FDA for safety and efficacy. Additionally, compounding facilities may not be FDA monitored and there is a risk of contaminants and patient dosing errors. Form is dedicated to providing quality evidence-based medical weight loss care. The National Obesity Medicine Association published an extensive position statement advising against using compounded peptides that also highlights the risk to individuals. Form Health is aligned with the Obesity Medicine Association’s position. We do not prescribe compounded medication.

Insurance coverage for Foundayo may be denied for several reasons:

1. The medication requires a prior authorization. A prior authorization is essentially a form that your medical team completes to answer questions related to the use of this medication and to ensure that it is medically appropriate and necessary for you to be taking it. A prior authorization does not guarantee coverage as medications that are not a covered benefit will not be covered even if you meet clinical criteria. Foundayo and weight loss medications can be quite expensive and often require prior authorizations for coverage. Your Form Health Care Team can assist with prior authorizations.
2. You do not meet the clinical criteria required for coverage. Foundayo is a covered benefit, but you don't meet the criteria set by their insurance which may be different from FDA criteria. Foundayo is FDA-approved for weight loss in adults with a BMI of 30+ or 27+ with a weight related medical condition such as high blood pressure or prediabetes. Some insurance plans have criteria for coverage that is more restrictive than FDA guidelines, such as requiring patients to have a BMI 40+. Coverage will depend on your individual plan.
3. This medication is not a covered benefit, including prescription medications. This typically depends on insurance benefits selected by your employer and is not related to the insurance company your plan is with. To see if a medication is a covered benefit, you may be able to view your plan’s drug formulary or call your insurance company to speak with someone directly.
4. Some insurance plans only cover weight loss medications like Foundayo if certain conditions are met. For example, you must have a BMI above a certain level you need to have proof that you have participated in an intensive lifestyle program consisting of a low calorie diet, increased physical activity and behavior change for at least 6 months; or you need to have already tried and failed or be unable to take other lower cost weight loss medications on the formulary first.
5. ‍If your medication was previously covered, but now you are being told it is denied this could be due to several reasons. The simplest is that a prior authorization renewal is required. Other reasons could be that your insurance formulary has changed and the medication is no longer a covered benefit or that there are new clinical criteria that you don’t meet. To learn more about your exact costs for Foundayo or other medications, contact your insurance company using the phone number on the back of your insurance card.

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Yes, prescriptions processed through your insurance count towards your deductible. However, prescriptions that do not get processed through insurance and are selected and paid for entirely out-of-pocket does not count towards an insurance deductible. It is important to reach out to your insurance provider to understand your plan benefits and coverage limitations as they will have the most up to date information.

Foundayo has undergone extensive clinical trials before receiving approval from the Food and Drug Administration. While it is not known if Foundayo will cause thyroid tumors or a type of thyroid cancer called medullary thyroid carcinoma (MTC), in studies with rodents, medicines like Foundayo caused thyroid tumors, including thyroid cancer. Watch for possible symptoms, such as a lump or swelling in the neck, hoarseness, trouble swallowing, or shortness of breath. If you have any of these symptoms, tell your healthcare provider. Do not use Foundayo if you or any of your family have ever had a type of thyroid cancer called medullary thyroid carcinoma (MTC). It is important to speak with your prescribing provider immediately at the onset of side effects, in order to adjust your treatment plan as necessary.