Week 55 Mounjaro Update: We’re the Drug Cops and We’re Here to Help!

I’m back with the latest installment of my Mounjaro-fueled foray into Type 2 diabetes control. At age 78, I’ve now spent over a year jabbing myself with my preferred GLP-1 receptor agonist, watching my HbA1c drop into smugly normal territory, trimming my pharmaceutical roster, and saying goodbye to seventy-five pounds of metabolic avoirdupois.

These weekly updates serve two purposes: to share my personal progress and to vent — with style — about the medical-industrial comedy that surrounds drugs like Mounjaro. For those of you starting out with GLP-1 therapy, I offer this mix of anecdote and invective as a cautionary tale. Yes, these drugs are powerful tools. No, they are not magic. Without commitment, effort, and at least a little dietary sanity, the only thing they’ll reliably shrink is your wallet.

My Appetite is Back

Let’s talk about the so-called “miracle” of appetite suppression. The YouTube pharmababblers — pumped full of sponsorships and pseudoscience — treat GLP-1s like Ozempic Fairy Dust. But I can tell you from experience: unless you plan to dose-chase into orbit, the effect fades. Mine lasted just long enough to rewire my eating habits toward low-carb territory, which suits me fine now that I’m focusing more on muscle than weight loss. I’m at the 7.5 mg dose, with no plans to go higher. Appetite suppression? Who needs it, already? Glycemic control is the goal — not accidental anorexia.

Mounjaro Ain’t Cheap!

Sticker shock alert: if your insurance doesn’t cover GLP-1s, you’re staring down $1,200 a month. Even with Medicare Part D and a drug plan, I’m shelling out $250/month for my Mounjaro fix. It’s enough to make you consider robbing a CVS — though ironically, they’d probably deny the claim. And now the insurers are finding new and exciting ways to “manage utilization,” which brings us to this week’s delightful screed.

The PBM Shuffle: EnGuide and the Great GLP-1 Shell Game

If you’re using GLP-1s to keep your beta cells from waving the white flag, congratulations — you’ve just been volunteered into a high-stakes farce run by Pharmacy Benefit Managers (PBMs). Think of it as “Squid Game,” but for your pancreas.

EnGuide: The New Dog in Express Scripts’ Kennel

As of June 15, Express Scripts has outsourced your Mounjaro refills to a startup called EnGuide Pharmacy — “powered by CHD,” which they swear stands for Certified Health Delivery and not Congestive Heart Disease, though I remain unconvinced. The rebrand promises “convenient home delivery,” which in PBM-speak means “we’re adding another layer of bureaucratic fog between you and your meds.”

Let’s call EnGuide what it is: a utilization management checkpoint, a rebate harvester in a lab coat, a denial machine with lipstick. You don’t need a pharmacy — you need a permission slip.

The Pre-Authorization Gauntlet

If your GLP-1 refills are starting to feel like Kafkaesque quests, that’s because they are. These so-called “designated pharmacies” specialize in exhausting you into compliance — or better yet, giving up. The only weight they help you lose is the crushing burden of hope.

CVS Joins the Party

Never one to miss a chance to profit, CVS Caremark has instituted its own “clinically aligned” GLP-1 centers. Think automated chatbots with lab coats and PowerPoint slides. You may be denied medication not because you’re noncompliant, but because you’ve lost “too much” weight. Yes, being too healthy is now a problem — just not for your insurer’s earnings report.

Walgreens? They’ve launched “Health Corner,” which is like telemedicine, except it’s run by people who used to work the cosmetics counter.

The Real Agenda

Please note that a subset of patients taking a GLP-1 for weight loss will need to be enrolled and engaged in a lifestyle modification program before receiving the medication. This requirement is chosen by your employer or health plan. You will be notified if you are in this program and advised what to do when you place your medication order.

—Evernorth Health Services

These PBM spinoffs aren’t here to help you — they’re here to reshape the narrative. Their goals are simple:

• Control cost (their cost, your health be damned)
• Harvest data (ever hesitate before hitting ‘Refill’? That’s logged)
• Steer behavior (click here to confirm you’re not abusing this miracle drug)

And if you want to keep using your preferred pharmacy? Sorry, that ship has been rerouted — probably to a container port in Shenzhen. You’ll need your doctor to fax a 27-page form to EnGuide’s secret lair while standing on one leg reciting the Hippocratic Oath.

Sidebar

What’s happening?

PBMs (Pharmacy Benefit Managers) like Express Scripts, CVS Caremark, and OptumRx are increasingly pushing GLP-1 prescriptions through designated specialty pharmacies — such as Evernorth EnGuide Pharmacy, a subsidiary of Cigna/Express Scripts. They claim it’s for “convenience.” It’s really about control.
What is a ‘designated pharmacy’?
It’s a locked gate disguised as a red carpet. You may still “choose” another in-network pharmacy, but that requires effort, paperwork, and frequently — your doctor’s direct involvement. For many, it’s easier to comply than to fight.
Why now?
GLP-1s like Mounjaro and Wegovy are expensive and wildly popular. PBMs want to curb usage, maximize rebates, and closely monitor patient adherence. Routing scripts through their own subsidiaries gives them tighter reins — and a bigger piece of the financial pie.
What changes for you?
You might need new prior authorizations.
You may face refill delays.
You’ll be nudged toward online portals, virtual “coaching,” and data-sharing “opt-ins.”
You’ll lose flexibility in choosing how and where your medications are dispensed.
Is this legal?
Yes. Is it patient-centered? Not even close. It’s a quiet recalibration of access, placing corporate interests over medical autonomy.
What can you do?
Keep accurate records of delays and denials.
Talk to your doctor about keeping a paper prescription on file.
Escalate unresolved access issues to your state insurance commissioner or attorney general.
Push back. The more noise patients make, the harder it becomes for these silent maneuvers to stay hidden.

Who Wins?

Not you. Not your doctor. Not even your long-suffering pancreas.

The big winners are:

• Evernorth/EnGuide, now raking in profits from “specialty care” and shadow rebates.
• Cigna, CVS, UnitedHealth, who’ve built vertical empires where denial is a service.
• Wall Street, who loves nothing more than “patient channeling” and “therapeutic rationalization” — euphemisms for “we made it so annoying they quit.”

What Can You Do?

Short of chaining yourself to the EnGuide loading dock, consider the following:

• Refill early and often.
• Get a paper script to take elsewhere.
• Alert your doctor when “transition of care” gets mentioned — it’s rarely a good thing.
• Document every delay, denial, and duck-and-cover — they may come in handy with your state board or Medicare appeal.

And above all: remember, GLP-1s may suppress your appetite — but nothing suppresses a PBM’s appetite for profit.

This Week on Mounjaro

I placed my first order with EnGuide. No glitches yet — but I’ll be watching. Probably harder than they’re watching me.

The medical carousel slowed this week: just one PT session and a Tuesday visit with Dr. DeLorean to review my recent CT scan. No tumors — hooray! But my iron levels still look anemic and hemoglobin is slightly low. He’s not worried. I am. So I’m watching this like a hawk — or, more appropriately, like a turkey guarding his giblets.

The Mounjaro Numbers

• Weight: 176.2 lbs — steady as she goes.
• Fasting Glucose: 107 mg/dL — a modest drop.
• Stelo Overall Average: 107 mg/dL — also down a notch.

Conclusion: Same Mounjaro, New Tricks, More Nonsense

This week’s lesson? The battle for better health doesn’t end at the injection site. GLP-1s might lower your glucose, but they won’t protect you from PBMs weaponizing “care coordination” against your sanity. As for me, I’ll keep taking the drug, watching the numbers, and telling the truth — because someone has to.

See you next week, unless I’ve been put on hold indefinitely by a robot named “Clara” at EnGuide.

For an annotated catalog of all my Mounjaro updates, please visit my Mounjaro Update Catalog page.