MyStart Health
Employer & marketplace coverage
Focused on insurance activation. Good for Medicare / employer plans.
Quick take
- MyStart Health is the strongest program for complex insurance situations — Medicare Advantage, state Medicaid, employer self-funded plans with restrictive PAs.
- $129/month platform fee plus medication (through insurance when possible); pricing is competitive once insurance activates.
- Specialized coverage team navigates state-level Medicaid rules, Medicare Advantage preferred drug lists, and employer carve-outs better than generalist programs.
- Clinical depth is adequate; the differentiator is the insurance navigation, not the clinical program.
- Right choice for patients whose other programs have failed PA or who have Medicare Advantage with quirky formulary rules.
Pros and cons
- Best-in-class insurance navigation, especially for Medicaid and Medicare Advantage.
- Team actually knows state-specific Medicaid PA rules — most programs don't.
- Employer self-funded plan navigation is strong; they identify carve-outs most competitors miss.
- Solid clinical team with obesity-medicine-credentialed physicians on staff.
- Transparent about when insurance won't work and when cash is cheaper.
- Reasonable monthly fee for the amount of insurance work involved.
- Longer onboarding than cash-pay programs — insurance verification takes 5–10 days before first visit.
- Not the cheapest option for patients with straightforward commercial coverage (Mochi is usually lower-fee).
- No compounded GLP-1 option; brand-name only.
- No behavioral or dietitian components; medical-first program.
- Smaller operational scale means capacity constraints during enrollment surges.
- Provider continuity is decent but not as tight as Form Health's.
What MyStart Health actually is
MyStart Health is a specialist telehealth program built around the hardest problem in GLP-1 access: complex insurance. Founded in 2022 by a team with backgrounds in benefits consulting and pharmacy network management, MyStart positioned itself from day one as the program that handles what others give up on.
The product: $129/month platform fee plus medication (through insurance when possible, LillyDirect/NovoCare cash channels when not). MyStart's internal coverage team — not an outsourced PA service — handles prior authorizations, appeals, Medicare Advantage navigation, and state Medicaid enrollment where eligible.
This is the right program for a specific situation: you've been denied a GLP-1 PA elsewhere, you have Medicare Advantage with restrictive formulary rules, or you have a complex employer self-funded plan with carve-outs. For those patients, MyStart is often the difference between getting covered medication and paying cash indefinitely.
The sign-up and insurance verification
Intake is longer than most programs — about 30 minutes covering medical history, prior weight-loss attempts, current medications, and detailed insurance information (plan name, group number, prescription BIN/PCN, employer if applicable).
Insurance verification is where MyStart earns the $129. A coverage specialist reviews your specific plan within 48–72 hours and identifies: covered GLP-1s on formulary, PA requirements, step therapy rules, quantity limits, and any carve-outs. You get a written summary before your first clinical visit.
If coverage is activatable, a PA is submitted within 24–48 hours of the clinical visit. If coverage isn't activatable, MyStart explicitly tells you and recommends the cheapest cash path (often LillyDirect).
Clinical depth: adequate; insurance is the differentiator
MyStart's physicians are U.S. licensed with some obesity medicine credentialing. Visit notes are thorough; follow-up cadence is monthly for the first 3 months, then quarterly. Continuity is reasonable — you typically see the same provider twice in a row.
What's missing: no behavioral layer, no dietitian. For those needs, MyStart is the wrong program. But for the PA-complex patient who just needs a prescriber who'll work the insurance, MyStart is unmatched.
Pricing: what you actually pay
$129/month platform fee — includes all prescriber access, insurance navigation, PA submission and appeals, coverage verification, and member portal.
Medication: through insurance (copay applies) when coverage activates, or via manufacturer cash channels when it doesn't.
Typical all-in monthly cost:
- Commercial insurance + Zepbound covered: $129 + $25 = $154/month (but often $0 after MyStart activates coverage you didn't know you had).
- Medicare Advantage + Wegovy for CV indication: $129 + copay varies = $150–$250/month depending on plan.
- State Medicaid in a covering state: $129 + $0–$10 copay = $129–$139/month.
- Self-pay when insurance fails: $129 + $349 (LillyDirect) = $478/month.
For uncomplicated commercial insurance, Mochi's $99 platform is cheaper. For complex insurance, MyStart's $129 is typically worth it multiple times over.
How it compares
vs. Mochi Health: Mochi is cheaper and handles most commercial PAs well. MyStart is better for complex cases — Medicaid, Medicare Advantage, employer self-funded carve-outs. If your insurance is straightforward, Mochi. If it's complicated, MyStart.
vs. Form Health: Form is the clinical program; MyStart is the insurance program. For a complex-insurance clinically-complex patient, Form often wins because the clinical work is deeper and the insurance work is adequate.
vs. PlushCare: PlushCare is general PCP with good insurance acceptance. MyStart is specialist insurance navigation. PlushCare is broader; MyStart is deeper on coverage specifically.
Verdict
MyStart Health is the right program for patients with complex insurance situations — Medicare Advantage, state Medicaid in covering states, employer self-funded plans with restrictive PAs, or prior PA denials. For that customer, MyStart's $129/month is often the difference between meaningful coverage and cash-only.
For uncomplicated commercial insurance, MyStart is adequate but unnecessarily expensive compared to Mochi. For clinically complex patients, Form Health is deeper. For strict cash-pay, TrimRx or Shed is cheaper.
Pricing breakdown
| Line item | Amount | Note |
|---|---|---|
| MyStart platform | $129/month | Includes insurance navigation + prescriber |
| Zepbound (covered) | $25/month | After PA activation |
| Wegovy (covered) | $0–$25/month | After PA activation |
| Medicare Advantage Wegovy (CVD) | Varies by plan | MyStart navigates formulary rules |
| State Medicaid (covering states) | $0–$10 copay | Varies by state and MCO |
Is MyStart Health right for you?
- Patients with Medicare Advantage plans and variable GLP-1 coverage rules.
- State Medicaid patients in covering states needing activation support.
- Employer self-funded plan patients with restrictive PAs.
- Patients denied PA at other programs who want a second attempt by specialists.
- Uncomplicated commercial insurance — Mochi is cheaper for the same outcome.
- Strict cash-pay patients — TrimRx, Shed, or Hims is cheaper.
- Patients needing behavioral or dietitian support.
Alternatives worth considering
Frequently asked questions
How much does MyStart Health cost?
$129/month platform fee plus medication (via insurance when coverage activates, or via manufacturer cash channels when not). For insured patients with newly activated coverage, all-in monthly cost is typically $129–$154.
Does MyStart Health work with Medicare?
Yes — MyStart specializes in Medicare Advantage navigation, including activating Wegovy under its cardiovascular risk reduction indication for qualifying patients. Medicare Part D cannot cover GLP-1s for weight management, but the CV pathway is a meaningful carve-out MyStart knows how to work.
Does MyStart Health accept Medicaid?
Yes in covering states. Medicaid coverage for GLP-1s varies by state — MyStart maintains current knowledge of each state's Medicaid PA rules and submits accordingly. States with strong coverage include California, New York, Pennsylvania, Michigan, Massachusetts, New Jersey, Washington, Oregon, and Illinois, among others.
What if my insurance won't cover GLP-1s?
MyStart will tell you explicitly rather than wasting time on PAs that won't succeed. In those cases, they can still prescribe via LillyDirect Self Pay ($349/month for Zepbound) or NovoCare Pharmacy ($499/month for Wegovy) — cheaper than most cash-pay programs once you net out the platform fee.
How is MyStart different from Mochi Health?
Both work prior authorizations. MyStart specializes in complex cases (Medicare Advantage, Medicaid, employer self-funded) and invests more operationally in coverage navigation. Mochi is cheaper and fine for straightforward commercial insurance. If your insurance has given you trouble elsewhere, MyStart is the program built for that.
See the full program comparison or take the Sherpa Matcher quiz to see if MyStart Health is your best fit.