While some rules regarding telemedicine were relaxed during the pandemic, those waivers have expired. Now, providers offering services in other states via telemedicine are required to have a license in the state they’re practicing, even if that practice of medicine is virtual through FaceTime, ZOOM, etc.

So if you’re considering the latest weight loss medications Ozempic, Wegovy or Moujaro, we offer the active ingredients from a compounding pharmacy found in these meds. Specifically, we have semaglutide, the active ingredient in Ozempic/Wegovy or tirzepatide, the active ingredient in Mounjaro. The first step is to schedule a consultation to find which medication may be appropriate for you. After getting baseline labs, you’ll sign up for one these once-per-week injections online, similar to a Netflix subscription. Every 28 days you’ll be charged for the medication of choice and we’ll ship them to your doorstep.

While these medications are paid out of pocket and not covered by insurance when getting them through our office, you’re benefiting from the convenience of getting these meds delivered to you rather than having to deal with the hassle of finding a pharmacy that 1) has the name brand drug and 2) has the dosage you need. Not to mention the hassle of trying to get insurance to cover these medications, which statistically will not happen.

So if you’re in California, Arizona, Hawaii or Florida, start by scheduling a consultation here.

The post Weight management now available for patients in California, Arizona, Hawaii and Florida first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.

What medications are we talking about and how do they work?

Ozempic, Wegovy, generic semaglutide, Rybelsus, Saxenda (iraglutide and approved in kids 12-17), Mounjaro (tirzepatide) are all Glucagon Like Peptide-1 (GLP-1) receptor agonists. The active ingredient in this class of drugs all end in “tide.” This will make it easier to spot these drugs in the future.

GLP-1 drugs stimulate the pancreas in type 2 diabetes to produce insulin. After initially producing too much insulin in patients with type 2 diabetes because of too much food intake and stimulating the pancreas to produce more and more insulin leading to insulin resistance, the pancreas gets “burned out.” GLP-1 drugs enhance insulin secretion in this scenario.

In addition to producing insulin, these medications suppress appetite and make you feel full by slowing the movement of food from the stomach to the intestines. Based on the studies of the various medications above, some result in a 15% weight loss (semaglutide that we have in the office) or up to 25 pounds in other studies.

These medications are all injections except for Rybelsus which is an oral tablet. However, Rybelsus didn’t result in as much weight loss in studies.

Ozempic was approved for type 2 diabetes in 2017 and found to have a side benefit of weight loss. Therefore, the manufacturer took the same medication and got approval specific for weight loss under the name Wegovy. So using this drug for weight loss is not off label. It is a legitimate, FDA-approved use.

Can the office just send the medication to me?

These medications are real medications and patients need to be monitored while on them. For that reason, all patients that are deemed candidates (more on this in a minute), must join our 6-month weight management program to get a health assessment, including bloodwork and an EKG, followed by weekly coaching sessions.

Who’s a candidate?

While some may believe this medication is being unfairly taken away from type 2 diabetics, this really isn’t an accurate assessment of the situation. Wegovy (semaglutide) is specifically approved for weight loss as long as you fit the criteria for obesity, which is to have a BMI of greater than 30 or greater than 27 if you have other comorbid conditions like type 2 diabetes or high blood pressure (calculate your BMI here). If you’re a candidate and a California resident, you can purchase a month’s supply of semaglutide  injections (the active ingredient found in Wegovy and Ozempic) from our office.

We can teach you how to give yourself the weekly injections in person or virtually once you’ve joined the weight management program. The initial consult (a cost of $100 that will go towards the cost of the program) and subsequent sessions can all be done virtually. Again, you must be a California resident because we can not ship these medications to other states.

How much does it cost? Will insurance cover it?

Our 6-month weight management coaching program is $1199. The non-coaching program is $350 and includes a bluetooth-enabled scale, journal and baseline labs (similar to the coaching program without the coaching). After that, the subscription to get compounded semaglutide or a prescription for Ozempic or Wegovy, if your insurance covers it, is $470 every 28 days. So whether it’s the compounded semaglutide shipped to your door or a prescription for the name brand drug, it’s $470 every 28 days.

If you’re going the insurance route, we’ll submit the prescription to a pharmacy of your choice that has the medication and correct dosage in stock and handle any pre-authorizations for $470 every 28 days, with the hope that insurance covers the rest of the cost. To check whether there’s a chance insurance will cover the name brand drug Wegovy, click here.

Additionally, if you attempt to use insurance for medication coverage, remember that the lower/starting doses of Wegovy are in short supply per the manufacturer and insurance coverage is statistically not likely in a majority of cases. If insurance doesn’t cover it or your dose is unavailable, we can still get the medication for you in the compounded version for the same monthly cost of $470 every 28 days.

Either way, you’re guaranteed access to the medication for $470 each month – either via a compounding pharmacy or through a prescription for the name brand drug from a traditional pharmacy.

What are the side effects?

Side effects include burping, bloated feeling, diarrhea and most severe, but rare, pancreatitis. This is why we continue to monitor patients on semaglutide in our weight management program rather than distributing the medication unmonitored. Based on study results, it’s unclear if someone who previously had pancreatitis can take this medication.

Many comments in our TikTok post asked about risks of cancer. Studies on lab rats showed an increase in thyroid cancer but is not necessarily the case in humans. If you have a history of medullary thyroid cancer or Multiple Endocrine Neoplasia (MEN) type 2, you should not take these medications.

Do you have to take it forever? What happens when you stop?

Based on current recommendations, you can continue to take the medication as long as it’s beneficial.

Many asked if you will gain the weight back if you stop the medication. A better way to look at it is, if you stop the medication but continue with other behavioral changes like a healthy diet and exercise, you would not gain the weight back.

But even more important, if you lose weight with the medication in combination with diet and exercise, then stop the medication and conscientiously continue the diet and exercise, not only will you keep the weight off, you’ll no longer have type 2 diabetes and won’t need the medication! Why?

Type 2 diabetes is caused by obesity and is reversible. So try this: Consider using the medication to jump start your weight loss journey but don’t stop there. Use this opportunity to start life anew with a healthy diet and exercise, reverse type 2 diabetes and stay off diabetes medications for good. (This advice does not apply to type 1 diabetes which is a very different disease and generally not curable in the same way type 2 diabetes is).

Is there a shortage of this medication?

Currently, we have a robust supply of semaglutide in our office for patients that meet the criteria for obesity. We obtain this generic, less expensive version of Ozempic and Wegovy from a compounding pharmacy.

Never heard of a compounding pharmacy? That’s ok, chances are you’ve used medication from a compounding pharmacy before.

Examples of what a compounding pharmacy offers:

• Allergic to a dye or certain ingredient in a medication? A compounding pharmacy would recreate that medication without the dye or allergen
• A child, or elderly parent that can’t swallow the pill form of a medication? A compounding pharmacy can recreate the medication in liquid form
• Ever received botox or filler at a doctor’s office? The topical numbing cream placed on the skin prior to treatment was made at a compounding pharmacy
• On bioidentical hormone replacement therapy (BHRT)? From a compounding pharmacy.
• Medications that are in short supply, including medication for COVID, can be produced by compounding pharmacies too

This last example is why we’re able to get semaglutide. It’s on the FDA’s shortage list, and as such, the FDA allows a compounding pharmacy to duplicate a commercially sold drug that’s currently unavailable or in short supply.

So what if semaglutide is removed from the shortage list? Then the compounding pharmacy we work with could no longer manufacture semaglutide. Unfortunately, that means patients who signed up for our 6-month coaching program after June 4th will no longer have access to the compounded version of the medication but if you have an ongoing subscription, we’ll provide you with a prescription for the name brand instead so either way you’re guaranteed access to the medication.

But we’re also hoping they won’t need the medication forever. Because our primary goal here is not for our patients to become medication-dependent for the rest of their lives.

We want our program to coach patients to a healthier lifestyle with diet and exercise. That way, if accessing medication becomes a problem, they would’ve at least had 6 months of coaching to strive for their goal weight with and without medication and then maintain it with newly developed behavioral changes learned in the  6-month program.

Quality standards of compounding pharmacies

In regards to the quality of medications produced by a compounding pharmacy, the facility we get semaglutide from is considered an “outsourcing facility,” as defined in The Drug Quality and Security Act, of 2013. That law created a new section, 503B, in the Federal Food, Drug, and Cosmetic Act. As such, an outsourcing facility is overseen and inspected by the FDA, along with state regulators.

Under the law, outsourcing compounding pharmacies must comply with section 503B and current good manufacturing practice (CGMP) requirements. In other words, they have very high standards to keep.

And we’ve had a great experience with this compounding pharmacy providing our semaglutide. A relationship that predates this particular drug. So for now, we have a robust supply of semaglutide and will maintain at least a 6 month availability while supplies last. This ensures anyone in our 6-month program will receive their meds even if the name brand medication goes off the shortage list and the compounding pharmacy is no longer able to make it.

As an aside, we’re hearing the shortage of the brand name drugs are actually a shortage of parts for the pen (think epipen) to administer the brand name versions. We don’t have a shortage in this sense either since we’re sending 4 prefilled syringes (not a pen) to patients as part of their medication regimen.

Also, patients that take these medications for type 2 diabetes or obesity do have other medication options as well as starting a healthy diet and exercise regimen to reverse and cure themselves of type 2 diabetes. Of course that’s easier said than done, but still true. Sometimes when we have medications to treat disease, we can lose sight of non-medicinal, behavioral-based cures.

If you’re serious about joining this program and want to be seen as soon as possible to get started, then you can pay the consult fee online here and be prioritized for the next earliest appointment. But before you do… 1) are you a California resident, 2) is your BMI > 27 with obesity related issues (type 2 diabetes, high blood pressure, etc) or a BMI > 30 and 3) don’t have any thyroid or pancreatic issues. If you can answer affirmatively to all three questions, then pay the consult fee here and our office will follow up with you ASAP to get you on the schedule for an in-person or virtual consult. Once we confirm you’re a candidate during your consult, then you can move forward with paying for the 6-month weight management program and the semaglutide (or appropriate medication) monthly subscription.

More questions? Email us at frontdesk@ph-ps.com or call/text us at (415) 923-3005 or book online here.

What if I have excess skin after the weight loss?

A year ago, we started the weight management program because we were seeing patients coming in for tummy tucks and mommy makeovers that had more weight to lose and were not candidates for surgery.

Rather than turning them away completely, we decided a weight management program would help them lose weight and if after the weight loss they did have too much leftover skin, we could help them with a body contouring procedure (like this before and after photo). Or maybe they’d lose the weight and not feel like they needed any surgery anymore.

Either way, we could help them achieve their goals. And for those patients that go through our program, lose weight and still want a body contouring procedure, the $1,199 fee paid for the program will be applied to any body contouring procedure. If you do feel you’re ready for a tummy tuck or other body contouring procedure, check current pricing on all of our services here.

Questions? Call/text (415) 923-3005 or email frontdesk@ph-ps.com. Or book a consultation online here so you can lock in a procedure with a deposit in 2022 before prices increase in 2023.

If you’re serious about joining this program and want to be seen as soon as possible to get started, then you can pay the consult fee online here and be prioritized for the next earliest appointment. But before you do… 1) are you a California resident, 2) is your BMI > 27 with obesity related issues (type 2 diabetes, high blood pressure, etc) or a BMI > 30 and 3) don’t have any thyroid or pancreatic issues. If you can answer affirmatively to all three questions, then pay the consult fee here and our office will follow up with you ASAP to get you on the schedule for an in-person or virtual consult. Once we confirm you’re a candidate during your consult, then you can move forward with paying for the 6-month weight management program and the semaglutide (or appropriate medication) monthly subscription.

The post Ozempic and Wegovy for weight loss: Q&A first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.

Why BMI isn’t enough

Sure BMI is better than looking at weight alone. Because even if a person weighs a lot, they may be very tall. And in that case, they would not be considered overweight.

However, BMI doesn’t take all nuances of body shape into account. For example, in the video below, the patient had a BMI of greater than 30. She would be considered obese. But there were several reasons she was a great candidate for a tummy tuck. First, she was healthy. No high blood pressure or diabetes. Second, her weight was concentrated in her thighs, not her abdomen.

So while her BMI was high, it didn’t accurately reflect the operation she wanted – skin removal from her abdomen. If most of her weight was in her abdomen, then it would be more appropriate for her to lose weight first since skin removal would not address the excess fat around her intestines (visceral fat). In her case, she her torso and abdomen were amenable to a tummy tuck and she had a great result.

If a patient is considered obese, they can still be offered a procedure. As long as no more than 5 liters of fat is removed in an operation, the patient can go home. With that limitation, they may have to come back in stages for surgery. But when patients undergo a cosmetic procedure that’s not medically necessary, there’s no reason to take unnecessary risks.

Video on Body Mass Index

Click here to check pricing on a procedure from Dr. Kaplan.

Click here for the original blog post written by Dr. Kaplan for BuildMyBod.

The post There’s more to it than BMI! [video] first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.