How It Works: Brand Name Meds + LSH
Process & Refill Overview
⚠️ Important Notice: As of 1/6/2026, Standard/Brand Name Medications will no longer be prescribed with refills due to limitations in the ability to alter dosages after submission with manufacturers. You will need to complete a refill request each month to refill (refill service fees have been waived). The $25 Standard/Brand-Name Treatment Plan fee covers one month of service.
Start with a Consultation
What happens
New patients begin with an initial consultation to review medical history, goals, and eligibility. After your consultation, you will be invoiced through the secure patient portal for your Standard/Brand Name treatment plan service fee of $25. This covers sending your prescription as well as access to your provider and support team throughout the month. It does not cover the cost of the medication.
Refill When You're Ready
What happens
When it's time to refill, you'll complete a refill request form:
- You may request a refill after 10 days from your last prescription.
- You will be invoiced for your $25 Standard/Brand-Name Treatment Plan fee, which covers sending your prescription and one month of service.
- If you were not previously on a GLP medication before starting with us, you will need a follow-up for your second refill.
Follow-Up Consultation Every 6 Months
What happens
To keep your care safe and up to date, a follow-up consultation is required every 6 months.
⭐ Maintenance Stage
If your provider determines that you no longer need dosage adjustments and you are in "maintenance stage," you are eligible to receive a 3-month prescription (one month's worth with 2 refills). You must be classified as maintenance and your dose on the prescription cannot be changed once submitted. The cost for maintenance treatment plans is $75 (equal to three monthly plans). Maintenance patients are able to refill every 3 months and are required to follow up with a provider every 12 months.
Insurance & Prior Authorizations
What LSH Does & Does Not Do
Please note: Lavender Sky Health does not accept insurance and does not submit prior authorizations. Patients who want to pursue insurance coverage will need to work directly with their insurance provider.
Using Your Local Pharmacy
What to expect
If your insurance has not confirmed coverage without a prior authorization, a local pharmacy may charge $1,000.00 or more for a single month of medication. LSH does not complete prior authorizations and does not work directly with insurance companies. All costs at your local pharmacy are self-pay.
Manufacturer Self-Pay Programs (Recommended)
LSH Recommends
Lavender Sky Health recommends using the self-pay programs for Zepbound®, Wegovy®, Saxenda®, and Foundayo®. These programs offer significantly lower fixed prices and ship directly to your home — no insurance billing required.
Available programs
Two programs are available depending on your medication:
- LillyDirect — for Zepbound® and Foundayo® (via GiftHealth or Amazon/Fuze)
- NovoCare Direct — for Wegovy® and Saxenda® (via Centerwell)
💡 Please note: Even if you choose to pursue insurance coverage on your own, LSH can still prescribe your medication. Should you obtain an approved prior authorization and wish to begin or resume care with us, we would be happy to do so.
Understanding Your Options
Cost Overview & Savings Programs
Zepbound®, Wegovy®, Saxenda®, and Foundayo® are prescription medications indicated for long-term weight management. Here is what you need to know about costs and your options.
Retail Cost Without Insurance
What to expect
When filled at a retail pharmacy without insurance, these medications can be highly costly — often ranging from $1,000 to $1,800 per month depending on the medication and dose.
Affected medications
Manufacturer Savings Programs
How they work
Both manufacturers — Eli Lilly and Novo Nordisk — offer savings programs that provide a significantly lower, fixed cash price. These programs do not bill insurance. Eligible patients pay the discounted amount and the medication ships directly to your home.
Programs available
- LillyDirect — for Zepbound® and Foundayo® (fulfilled via GiftHealth, Amazon, or Fuze)
- NovoCare Direct — for Wegovy® and Saxenda® (fulfilled via Centerwell)
Zepbound® (Tirzepatide)
By Eli Lilly — 3 Options Available
Auto-Injector Pens
Available From
LillyDirect or your local pharmacy
Best For
Patients who have insurance coverage or qualify for a manufacturer savings card or coupon.
What It Is
A pre-filled, single-use auto-injector pen designed for once-weekly dosing.
Cost
Without insurance, pricing typically exceeds $1,000/month.
Available Doses
If Using LillyDirect
You will receive a text message within 24 hours of order placement.
- You will be given the option to choose Amazon or Fuze for fulfillment and delivery.
- The medication is overnighted to your shipping location.
KwikPens
Available From
LillyDirect or your local pharmacy
Best For
The lower-cost option, well-suited for self-pay patients.
What It Is
A prefilled, single-patient-use KwikPen for once-weekly subcutaneous dosing, with 4 fixed doses per pen.
Cost
$299 (2.5mg) · $399 (5mg) · $499 (7.5mg) · $699 (10mg–15mg)
* 7.5mg–15mg drops to $449/month if ordered every 45 days
Available Doses
If Using LillyDirect
You will receive a text message within 24 hours of order placement.
- You will be given the option to choose Amazon or Fuze for fulfillment and delivery.
- The medication is overnighted to your shipping location.
Single-Use Vials
Available From
LillyDirect self-pay pharmacy via GiftHealth
Best For
A popular option for patients without insurance coverage for Zepbound.
What It Is
Small vials requiring you to draw the medication into a syringe for a once-weekly injection. Comes in a 1-month supply (4 vials).
Cost
$299/month (2.5mg) · $399/month (5mg) · $449/month (7.5mg–15mg) when ordered every 45 days
Available Doses
If Using LillyDirect (via GiftHealth)
GiftHealth will notify you via text and email within 24 hours that your prescription has been received.
- A secure checkout link will be sent to you within 48 business hours to complete your order.
- Your medication ships directly to your home, or select Walmart Pharmacy Pickup if available in your area.
Wegovy® (Semaglutide)
By Novo Nordisk — 2 Options Available
Auto-Injector Pens
Available From
NovoCare Direct or your local pharmacy
What It Is
A pre-filled, single-use auto-injector pen used once weekly.
Cost
NovoCare self-pay price: $349/month for all doses. With insurance, NovoCare can verify coverage and apply eligible savings cards. Prices vary at local pharmacies.
Available Doses
If Using NovoCare Direct (via Centerwell)
Orders are processed within two (2) business days.
- You will receive a welcome text message and a consent form to complete.
- Your medication ships directly to you, arriving in approximately 7–10 business days.
Oral / Pill Form
Available From
NovoCare Direct or your local pharmacy
What It Is
An orally ingested pill taken once daily (or as prescribed).
Cost
NovoCare Direct: $149–$299/month depending on dose. Local pharmacy costs will vary.
Available Doses
If Using NovoCare Direct (via Centerwell)
Orders are processed within two (2) business days.
- You will receive a welcome text message and a consent form to complete.
- Your medication ships directly to you, arriving in approximately 7–10 business days.
Foundayo® (Orforglipron)
By Eli Lilly — Oral Option
Oral / Pill Form
Available From
LillyDirect or your local pharmacy
What It Is
An orally ingested pill taken once daily (or as prescribed).
Cost
LillyDirect: $299–$699/month depending on dose. Local pharmacy costs will vary.
Available Doses
If Using LillyDirect
You will receive a text message within 24 hours of order placement.
- You will be given the option to choose Amazon or Fuze for fulfillment and delivery.
- The medication is overnighted to your shipping location.
Saxenda® (Liraglutide)
By Novo Nordisk — Daily Injection
Multi-Dose Pen
Available From
NovoCare Direct or your local pharmacy
What It Is
A multi-dose pen used once daily, requiring a daily injection.
Cost
Varies widely based on insurance, pharmacy, and savings program eligibility. Check NovoCare Direct for coverage or self-pay pricing.
Available Doses
If Using NovoCare Direct (via Centerwell)
Orders are processed within two (2) business days.
- You will receive a welcome text message and a consent form to complete.
- Your medication ships directly to you, arriving in approximately 7–10 business days.
Frequently Asked Questions
Common Questions About Brand Name Medications
My pharmacy says they reached out to my provider but haven't received a response — what should I do?
▼The message your pharmacy received was most likely a request for a prior authorization. Please note that Lavender Sky Health does not complete prior authorizations. As a result, prescriptions filled through your pharmacy are self-pay, and any costs are due directly through the pharmacy.
Why doesn't Lavender Sky Health do prior authorizations?
▼At this time, we do not submit prior authorizations on behalf of patients. Prior authorization requests are frequently denied and, when approved, often require multiple appeals over an extended period of time. These processes commonly require detailed clinical information — such as physical examination findings, diagnostic testing, and longitudinal medical history — that are best obtained and documented by a patient's primary care provider through in-person evaluation.
If you would like to pursue a prior authorization, we recommend contacting your insurance company directly to understand their specific qualification criteria and discussing your options with your primary care provider, who is best positioned to support the authorization and any necessary appeals.
Should you obtain an approved prior authorization and wish to begin or resume care with us, we would be happy to do so.
What happens after my order has been submitted?
▼The next steps depend on the pharmacy option you selected:
Local Pharmacy: Your prescription will be sent there electronically. LSH does not complete prior authorizations and does not work directly with insurance companies. All medication costs at your local pharmacy will be self-pay.
LillyDirect (GiftHealth — Zepbound Vials):
- Communication: GiftHealth will notify you via text and email within 24 hours that your prescription has been received and is being processed.
- Checkout Link: A secure checkout link will be sent within 48 business hours to complete your order.
- Delivery: Shipped directly to your home (or Walmart pharmacy pickup, if applicable) once payment is complete.
- Refills: GiftHealth will send a text message approximately 21 days after your last checkout to initiate the refill process.
Novo Nordisk (NovoCare — Wegovy / Saxenda):
- Communication: You will receive a text or phone call from the pharmacy with instructions.
- Checkout Link: Follow the link to create an online account where you'll complete payment and schedule delivery. The checkout is secure and completed online — not via text message.
- Delivery: Medication ships free directly to your home (local pharmacy pickup may also be an option).
- Refills: NovoCare Pharmacy will contact you with reminders when your refill is due.
It's been more than 21 days and I still haven't heard back from LillyDirect — what should I do?
▼If you've completed two months of medication (or three months if you purchased an Extended Treatment Plan), your next step depends on your situation:
- Schedule a follow-up consult with your provider if you're new to this medication or if a follow-up was recommended at your last visit.
- Otherwise, submit a refill request so your provider can send additional refills to the pharmacy.
It's been a while and I haven't heard anything from my local pharmacy — why?
▼You may not have heard from your local pharmacy because they are requesting a Prior Authorization. Contact the pharmacy directly and inquire.
Please note that Lavender Sky Health does not complete prior authorizations. As a result, prescriptions filled through your pharmacy are self-pay, and any costs are due directly through the pharmacy.
My local pharmacy has requested an ICD code — what do I do?
▼This can be discussed with your LSH provider. Contact them through the secure patient portal. LSH can submit a code on your behalf if clinically appropriate.
⚠️ Please note: Submitting an ICD code does not guarantee insurance coverage.