What Cornerstone Can and Can’t do for Medical Weight Loss:

Let’s be glass half full and start with the CAN’s:

1. Your doctor can meet with you and discuss their decades of experience with all medications that have been FDA approved for medical weight loss, their risks and benefits, the science behind the design of the medications and how these affect your physiology.
2. Your doctor can help you decide if NON-FDA supplements/medications/procedures are safe or unsafe for you.
3. Your doctor can determine if your weight presents risks for future debilitation or disease. We can give a more scientific perspective of body habitus and metabolism as opposed to societal or cultural influence.
4. If you and your doctor determine a medication is appropriate to try, we will prescribe it, IF your insurance company denies payment (which is highly likely), we can submit a “prior authorization”. A prior authorization is an attempt by your insurance company to appear that they are not trying to keep your money. We all know that is what they are doing. Submitting a “prior authorization” is most of the time fruitless and we have attempted every possible way to find the magic words to authorize your medication. It is a dastardly process that bleeds us of our staff’s time where they are pitted against endless telephone holds, disrespect, and the impossibility of conquering a multi-national corporate business. The good news: We will give it the college try once!
5. We will send your doctor’s prescription to the pharmacy of your choice. We would much prefer to write your prescription on a piece of paper so you could shop at a multitude of pharmaceutical suppliers, thereby granting you freedom. Alas, California State Government passed a law that all prescriptions MUST be electronic. We don’t know the logic behind this other than to support large corporate pharmacies dealing in high volume (e.g. CVS) and supporting the electronic medical record industry/business (at the expense of your doctor and their practice).
6. Please see prior article entitled “AKA The Wild Wild West of Medicine”
7. You and your doctor will decide how to monitor your progress and guide you through using medical weight loss safely. We will also monitor evidence based biomarkers to help you interpret if the medication is preventing and treating conditions that are influenced by weight/body habitus.

And now for the CAN’Ts:

1. We can’t change the pharmaceutical industrial complex and it’s extremely powerful endeavors to make a large profit off of their medical products. (Please read this again because I can’t state this in a nicer way…)
2. We do not have a magic key to know or understand price variance of all medications at all pharmacies.
3. Our very expensive EMR is supposed to interface with your insurance product to give us an indication if your medicine will be covered by insurance. This is a pathetic function that is wrong over 50% of the time and the ONLY way to know if a medicine is truly covered is some mystical magic key owned by the pharmacies that TRULY interface with your insurance company and tell you that: “Yes indeed, this medication is not covered”. But occasionally one will win the lottery and you will have some coverage. This is the reason we will almost always try to select a generic drug that will work well for you and be cost effective.
4. Your doctor and staff are not somehow more powerful than the suppliers of medications.

After reading this you may think that your friend at Kaiser has a much easier life. They do. Their drug formulary is very restrictive and by eliminating choice they eliminate any possibility of strife. Most of the time the patient is not aware that there are choices beyond what is offered. This makes business/life much easier for the system.

We at Cornerstone favor choice– even if it is fraught with navigating institutional greed and buffoonery!

Yours in optimized care,

Ross Pirkle, MD MS