How Calibrate Works to Get Medication Coverage

Once you join Calibrate, our Support and Medical Teams will work hard to help you get your medication covered by insurance so you can focus on taking control of your health. We use a team-based approach to navigate the prescription process.

The Medical Team is responsible for evaluating your health, determining the appropriateness of medication, and providing counseling and coordination of care.

The Benefits Navigation Team works with external pharmacies and monitors nationwide GLP-1/combined GLP-1 inventory for existing and newly-approved medications to help you receive your medication as quickly as possible.  Note: Calibrate is not a pharmacy and we don’t receive any remuneration from prescribing or dispensing medications.

The Support Team is here to connect the dots between you and our internal teams. Think of this team as the central command center for your prescription.

Calibrate clinicians prescribe GLP-1s because research shows that they are the most effective for long-term sustainable metabolic health and weight loss.  

Here are some things you should expect about getting medication coverage after you have joined.

How does the medication approval process work?

GLP-1s are a class of medications that include several different brand names, and insurance coverage for each can vary by health plan. 

Following your video visit with a board-certified Calibrate clinician (where you’ll discuss your lab results and health history), your Medical Team will prescribe a GLP-1 that’s medically appropriate for you. 

The Benefits Navigation Team will then work to get that  medication covered by your insurance. The process often requires us to submit  prior authorizations, which are required by your insurance company. A PA is an extra step insurance companies take to review your case and make sure that your prescription meets the medical criteria for coverage. It is not uncommon for multiple PAs to be submitted before a medication is approved.

How long does the approval process typically take?

The approval process timeline will vary by member, but it typically takes 6-8 weeks after your Calibrate clinician’s appointment to receive your medication. If we aren’t able to get your initial GLP-1 approved for $25/month (after any deductible has been met) within 90 days of your video clinician visit, you’re eligible to request a refund (terms here). 

How do you get my copay down to $25 or less per month?

After our team has gone through the insurance approval process with your prescription, we’ll also be sure a manufacturer coupon is applied when available to help bring down your copay to around $25 per month, unless you are on a high deductible plan, in which case you will first need to pay through your deductible before the medication is covered for around $25 or less per month.

Do I need to meet with my Calibrate clinician again to continue receiving medication?

After your 1:1 video visit with your Calibrate clinician, you’ll check in with your Medical Team in the app at set milestones—not as video visits this time, but in questionnaire form. These check-ins will be released at set milestones throughout your Reset and will help inform your ongoing program. You’ll receive a prompt in your app home screen to complete these. If you need to reach the Medical Team at any other time, you can visit the Support Center in the Calibrate App for assistance.

Have more questions? Reach out to our support team in our app.