Denied: Why Patients Are Going Around the System

This is why people like me end up turning to online compounding pharmacies instead of going through the traditional system.

You do everything right—see your doctor, get a prescription, follow the process—and still get denied. 

Just to have a little fun with this, I sent them the following email:

Subject: Wegovy Denial

I received your denial letter for Wegovy.

I’ve decided not to pursue the appeals process. Based on my experience, it is time-consuming and does not offer a timely path to care.

Instead, I have sought treatment through an alternative route that allows me to access medication more directly, at a significantly lower cost, and without the delays associated with the traditional insurance process.

I wanted to share this because it highlights a broader issue: when the process through insurance becomes too slow, restrictive, or costly, patients will look elsewhere for solutions.

Sincerely,
John Bottrell

I had an appointment with my ENT today.

I usually see the PA now instead of Dr. Hengy. Nothing against him—good doctor, smart guy—but his office is in Manistee. That’s a 40-minute drive. The PA is in Ludington, just a few blocks from my house. Easy choice.

I’ve been on allergy shots since 2021. If you’ve ever done them, you know the routine. You start twice a week, then once a week, then every other week. That part is easy to remember.

Then it gets weird.

Every three weeks. Once a month.

That’s where I fell off.

I hadn’t been in since December. I didn’t even realize it had been that long, but she told me—almost five months.

And I’ll be honest, I was expecting a lecture.

Didn’t happen.

She was actually kind of excited.

She said, “You’ve gone almost five months without shots, and you’re not having symptoms?”

I said, “Yeah, I feel fine.”

She said, “It’s allergy season… let’s test it.”

I liked that.

No guilt. No pressure. Just, “let’s see what happens.”

So we decided to stop the shots—for now—and see how I do.

I asked her how long I could go without having to start all over, and she said quite a while. That made the decision easier.

I also brought up Singulair. I told her if I had stayed on shots, I was thinking about coming off it. But honestly, I don’t have side effects from it. It’s cheap. It works. So for now, I’m staying on it.

Then I did something I don’t usually do with doctors.

I was honest.

I told her I’ve actually been doing fine in the spring even before the shots—as long as I’m on Singulair. And I admitted that part of the reason I went along with allergy shots in the first place was because Dr. Hengy was the first doctor in a long time who actually wanted to try something different.

That’s hard to say to a doctor.

But I said it.

And she handled it perfectly. Didn’t get defensive. Didn’t push back. Just took it in and moved on.

That felt good.

We set up a six-month follow-up. I told her straight up, “If I don’t schedule it now, I won’t come back.” She laughed and agreed. At that appointment, we’ll decide what to do next.

She also said if I start having symptoms at all, just call and we’ll restart the shots.

Simple.

Now, here’s the honest part.

I can’t say I’ve noticed a huge difference with the allergy shots.

But I also haven’t really tested it.

Flipping through old baseball cards has always been a trigger for me—tight chest, symptoms. I haven’t tried that lately. But I have been going through old photos, and that hasn’t bothered me at all.

So maybe they helped.

Or maybe the Singulair is doing most of the work.

Hard to say.

And yeah, part of me thinks, “well… it didn’t hurt.”

I hate that phrase. I hear it all the time at work with albuterol. But in this case, it kind of applies.

Either way, I walked out of that appointment feeling good.

No pressure. No lectures. A plan that made sense.

We’ll see what happens.

This Works—So Why Are They Trying to Take It Away?

In my first post, I shared how I got started with a GLP-1 after insurance denied coverage. In the second, I explained what compounding pharmacies are and why they’re cheaper.

This post is about something different.

Why all of this is under pressure right now. Why does it feel like it’s being taken away?

You can feel it.

The more people start finding out about compounded GLP-1s, the more pushback there is.

Pharmaceutical companies don’t like when people go outside the system and spend their money somewhere else. And regulators? They step in when something grows this fast, asking questions about safety, sourcing, and whether the rules are being followed.

And here’s the part that matters to me:

They aren’t getting $1,700 from me.
They aren’t getting $300.
They aren’t even getting $200.

I can’t afford that. Most people can’t.

If compounding pharmacies didn’t exist—if they didn’t make these medications available—then I wouldn’t be taking them at all.

Not unless prices came back down to reality.

And here’s the part that really gets me—they want to take this option away and push everyone back through the same system. You have to schedule a doctor’s visit—there’s time and money. Then wait for approval. Then deal with insurance. Then go to the pharmacy. Pay again. Drive there. Wait in line. All of it adds up—time, stress, gas, money. And after all that? You still have to take their dose, their schedule, their one-size-fits-all approach. You have no control. Compare that to having something show up at your door, being able to manage your own dosing, and actually making it work for your life. That difference matters.

And honestly, it doesn’t take a genius to see why this is happening.

On one side, you’ve got companies like Eli Lilly and Company. They built these drugs. They spent years and billions getting them approved by the U.S. Food and Drug Administration.

But here’s the reality for people like me:

You’re told, “This medication could help you.”
And then right after that—“You can’t have it.”

Insurance denies it.
The price is $1,500… $1,700 a month.

So what are we supposed to do?

Just sit there and stay unhealthy?

No.

We find another way.

And when we do—when we finally find something that works and we can actually afford—it changes everything.

And that’s when the pressure starts.

Because now it’s not just about the medication anymore.

It starts to feel like control.

Like they don’t want us to have control over what we put in our bodies.
Like they don’t want us to be able to afford it unless we go through their system, on their terms, at their price.

And yeah—maybe that’s not how they’d say it.

But that’s how it feels on this side of it.

So now you’ve got the U.S. Food and Drug Administration stepping in more.
You’ve got pharmaceutical companies protecting their patents and their market.

Pressure from both sides.

And right in the middle?

Us.

People who are just trying to get healthier without going broke doing it.

And this is the part that frustrates me the most:

The system works great… if you can afford it.

If you can’t?

You’re out.

So when something like compounding gives people a way in—a way to actually take the medication, to control dosing, to make it work financially—you’re going to see people take it.

Of course they are.

This isn’t about trying to game anything.

It’s about not being locked out.

Is compounding perfect? No.

There are trade-offs. People need to understand that.

But the bigger issue is this:

People are being priced out of something that could help them.

And until that changes, this isn’t going away.

Because this isn’t just about a drug.

It’s about whether regular people actually get a say in their own health.

Let Me Get the Medicine I Already Know I Need

I like doctors. I like pharmacists. I like insurance companies. I like the U.S. Food and Drug Administration. They all serve a purpose.

But there are certain medicines that shouldn’t require going through all of them every single time.

And I’m not talking about new diagnoses or complicated cases. I’m talking about people with established conditions who already know what works for them. I still see my doctor twice a year. I’m not trying to avoid care—I just don’t need to keep jumping through the same hoops over and over.

For instance, I need Trelegy Ellipta. One puff a day. I’ll likely need it for the rest of my life unless something better comes along. It’s already been determined that I need it to breathe. So why do I have to keep going through a doctor, a pharmacy, and an insurance company just to get it? It should just be automatically available to me.

Same with my blood pressure medication, like lisinopril. Doctors are helpful in figuring out what I need. But once that’s established, why do I have to keep jumping through hoops? I’m not saying it should be free—but it should be accessible and reasonably priced.

There’s a difference between maintenance meds, rescue meds, and acute treatments—and right now, the system treats them all the same.

Maintenance meds should be automatic once they’re established.

Rescue meds—like Albuterol—should be easy to access. It’s proven to be safe for shortness of breath. Why do I need a prescription for that? It should be on the shelf—over the counter—like Tylenol or Ibuprofen.

And yes, people worry about overuse. But the real issue isn’t the albuterol—it’s the uncontrolled asthma behind it. That’s where doctors come in. It’s called education and follow-up, not restriction.

Hell, epinephrine inhalers are generally considered more risky than albuterol, and they’re already available over the counter. If the goal is safety, then give people better options, not fewer. I’d bet the use of epinephrine inhalers would drop off pretty fast if albuterol were just as easy to get.

Then there are acute treatments like corticosteroids, such as prednisone. I understand these need more oversight. But if I’m having an asthma flare and I’ve been down that road before, there should be a faster, easier way to access them than paying $40 just to be told what I already know I need.

Right now, they tell me I need a refill. My doctor has me come into the office twice a year. I pay $40 for that visit. Then I pay whatever price the pharmaceutical company and insurance decide. And after insurance, I’m sure the system is making a lot more than that $40.

So let me just get the medicine I need.

Of course, I’m not saying you shouldn’t see your doctor regularly. They’re needed to monitor your health and adjust medications when necessary. But once it’s established that I benefit from a certain dose, why do I have to call for a refill every six months? Why not just auto-renew it unless something changes?

It would save patients a lot of stress—and a lot of money.

And honestly, it would make the system work the way it was supposed to in the first place.

Compounding Pharmacies — What They Are and Why GLP-1s Cost Less

In my last post, I shared how I got started with a GLP-1. My doctor wanted me on Wegovy for prediabetes and weight loss, insurance denied it, and I wasn’t about to pay $1,700 a month out of pocket. That led me down the road of finding alternatives, which is how I ended up using a compounded version of tirzepatide.

Since then, I’ve had a lot of people ask the same question: what exactly is a compounding pharmacy, and how are they able to sell this stuff so much cheaper?

A compounding pharmacy is a licensed pharmacy that custom-makes medications for individual patients. Instead of a one-size-fits-all pen, they can adjust the dose, formulation, or delivery based on what a provider prescribes. This isn’t new—it’s actually how medicine used to be practiced before mass-produced drugs became the norm.

Back in the 1800s, you’d go to a doctor with a symptom, get a prescription, and then the pharmacist—sometimes the same person—would mix the medication right there. There was no one-size-fits-all dose. The dose was tailored to you.

In the case of GLP-1s like tirzepatide, that often means getting a vial instead of a preloaded pen, and drawing up your own dose with an insulin syringe.

That’s where the cost difference comes in. The brand-name versions—like Zepbound or Mounjaro made by Eli Lilly and Company—are patented, heavily marketed, and come with all the research, development, and delivery systems built in. You’re paying for all of that. Compounded versions don’t carry those same costs, so they’re often a fraction of the price.

In my case, I’m paying about $300 for a 50 mg vial. It comes with bacteriostatic water, syringes, and instructions. At lower doses, that can last more than a month. And instead of being locked into a preset weekly pen, I can adjust my dosing. If I’m doing well on a lower dose, I stay there. If I need to move up, I can. That flexibility has been one of the biggest benefits.

That flexibility also helps with side effects. If higher doses are causing symptoms like nausea, one option is to split the weekly dose—taking half at the beginning of the week and the other half a few days later. This avoids a large single dose, which can make it easier on your system. It also keeps the medication more steady in your body, so you don’t feel it wearing off toward the end of the week.

Another thing worth understanding is what this medication actually is. Tirzepatide is a peptide—a short chain of amino acids. The easiest way to think of peptides is like keys fitting into locks. Your body has receptors, and when the right peptide binds to the right receptor, it triggers a specific effect. In this case, tirzepatide targets GLP-1 and GIP receptors, helping regulate blood sugar, slow digestion, and reduce appetite. That’s why people lose weight on it, and often with relatively targeted effects.

Now, here’s where things get a little gray, and it’s important to be honest about it.

Some of these online sources don’t operate exactly like a traditional pharmacy. You’ll sometimes see language like “for research use only.” That’s there for legal and regulatory reasons. At the same time, it’s not hard to see why people are going this route. When something costs $1,700 through the traditional system and a few hundred dollars through an alternative channel, people are going to look for options.

But that also means there are trade-offs.

These products are not the same as FDA-approved, brand-name medications. They don’t go through the same level of oversight, and quality can vary depending on where you get them. You’re also taking on more responsibility—mixing the medication, measuring doses, and giving the injection correctly. That’s not nothing.

For some people, that level of involvement works. For others, it’s not a good fit.

I also had a friend who had been taking this for years before I ever started. That made it easier for me to consider. When she first told me about it, my thinking was pretty simple: You’ve been on it for years and you’re still here—it must be safe. It worked for you, so maybe it could work for me too.What I will say is this: people aren’t doing this because they want to play pharmacist. They’re doing it because they’re priced out of the system.

If insurance covered these medications, or if pricing made sense, most people would go through their doctor, pick it up at the pharmacy, and never think twice about it. Instead, people are left figuring it out on their own.

For me, and for a few friends, it’s worked. One of them is down 50 pounds and feels great. I’m losing weight, my appetite is under control, and I feel like I finally found something that works.

That’s why I wrote this follow-up—to explain what’s actually going on behind the scenes, what a compounding pharmacy is, and why more and more people are going this route.

It’s not perfect. But for a lot of people right now, it’s the only realistic option.

When Insurance Said No, I Found Another Way: How I Now Afford the Weight Loss Drug of My Choice

My doctor wanted me on a GLP-1—both to get my blood sugar down (I was prediabetic) and to help me lose weight. He prescribed Wegovy. My insurance denied it.

So I couldn’t get it. And paying out of pocket would have been around $1,700 a month.

A few months later, I learned about Trump Rx. I told my doctor I could get it for about $200 a month, and that got me started. But then during that first month I realized the catch—after a couple months, the price jumps to around $450. GoodRx and the deals on the pharma sites all work the same way.

That’s what got me looking for alternatives.

What I found is there are online options offering compounded versions of these medications. Instead of the expensive auto-injector pens, you get a vial, mix it with bacteriostatic water, and use a simple insulin syringe. Much cheaper.

A friend introduced me to the company and their website. I won’t share the name here, but if you want more information, you can email me using the link to the right.

Because I’m the one paying for it—and making the decision—I skipped Wegovy and went straight to tirzepatide—the medication behind Zepbound—for a fraction of the cost (not the brand name). I chose it because it targets two pathways—GLP-1 and GIP—and has been shown to help people lose more weight than semaglutide.

The cost is about $300 for a 50 mg vial. It comes with bacteriostatic solution, mixing syringes, and insulin syringes, along with instructions so you can prepare and use it properly.One vial can last more than a month, especially at lower doses, and you can control your dosing instead of being locked into a preset pen.

It’s nice. No doctor. No insurance. Simple. Easy. Inexpensive.

A couple things to be clear about:

• This is compounded, not brand-name
• It’s not exactly the same as what you get from the pharmacy
• You’re trading cost for convenience and tighter controls
• You need to know how to mix the medication, measure the dose, and give the injection properly
• You also need to understand dosing—what to take and when (or if) to increase

But because you’re essentially your own caregiver, you have some flexibility. For example, if the plan says to move up to a higher dose but I’m still losing weight on the current dose, I just stay where I am.

That’s the freedom of it.

But here’s the bigger issue:

People aren’t going this route because they want to. They’re doing it because they’re getting priced out.

If insurance covered these medications—or if pricing made sense—most people would just go through their doctor and pharmacy and be done with it.

Instead, people are left figuring it out on their own.

For my friends, this has worked great. One of them has lost 50 pounds and said, “I love this.” That’s how I was introduced to it—and so far, I’m losing and loving it too.

When BiPAP Works… and the Blood Gas Looks “Worse”

Here’s a scenario many respiratory therapists and clinicians have seen.

A chronic CO₂ retainer wears their BiPAP all night.
Morning labs come back.

And suddenly…

The pH is alkalemic.
The bicarbonate is higher.
The base excess is elevated.

At first glance, it looks confusing.
Shouldn’t the gas look better?

Actually — this is often a sign that BiPAP worked.

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The Setup: Chronic CO₂ Retention

Many patients with:

• COPD
• Obesity hypoventilation syndrome
• Chronic respiratory failure

Live with chronically elevated CO₂.

For example:

• CO₂ in the 60–70 range
• pH near normal
• Elevated bicarbonate

How does the body tolerate this?

The kidneys compensate.

They retain bicarbonate to buffer the respiratory acidosis.
This is slow compensation — it takes days.

So over time, these patients develop:

• High CO₂
• High bicarbonate
• Near-normal pH

This becomes their baseline.

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Then Comes a Good Night on BiPAP

The patient wears BiPAP consistently overnight.

Ventilation improves.
CO₂ is blown off more effectively.
Gas exchange improves.

But here’s the key:

The kidneys cannot adjust quickly.

Respiratory changes happen in minutes to hours.
Renal compensation takes 24–72 hours.

So what happens?

• CO₂ improves overnight
• Bicarbonate remains elevated
• pH rises

Result:

Metabolic alkalosis with alkalemic pH

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It Looks Like This

Chronic respiratory acidosis (CO₂ ~63–65)
Renal compensation (chronically elevated bicarbonate)
Improved ventilation overnight with BiPAP
Kidneys can’t adjust quickly → bicarbonate stays high
Result → metabolic alkalosis / alkalemic pH

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Why This Is Actually a Good Sign

When you see this pattern, it often means:

• The patient wore their BiPAP
• Ventilation improved
• The body is adjusting

In other words:

The therapy worked.

It may look worse on paper — but clinically, it's often reassuring.

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A Common Clinical Pearl

Chronic CO₂ retainers often develop post-hypercapnic metabolic alkalosis when ventilation improves.

This happens:

• After BiPAP
• After intubation
• After improved ventilation
• After resolving respiratory failure

It’s not unusual.
And usually, it resolves gradually.

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Why It Still Matters

Significant metabolic alkalosis can:

• Reduce respiratory drive
• Promote CO₂ retention later
• Make weaning more difficult

So it's worth:

• Monitoring
• Checking electrolytes
• Watching trends

But in most cases, it’s expected physiology — not a problem.

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The Bottom Line

Sometimes when BiPAP works…
the blood gas looks “worse.”

But when you understand the physiology, it makes perfect sense.

And often, it’s actually a quiet sign of improvement.