Wegovy moving Tiers on BCBS FEP

[Anonymous]

Anonymous wrote:I got zepbound at $350 like above pp and am on bcbs fep. I was not required to try any other medications first either. However I am only covered until May this year.

Basic or standard? Thanks.

[Anonymous]

Anonymous wrote:

Anonymous wrote:My first fill for 2025 is at CVS and estimated at $643. Had been paying $25.

JFC I am annoyed by this and the greed of BCBS. I do not understand how an insurance company can justify this price change. It's criminal. I just started Wegovy last month. I'm not entirely sure what to do now. What are the chances of getting a Tier exception?

It's health insurance -- not subsidized health care. It isn't remotely "criminal."

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:My first fill for 2025 is at CVS and estimated at $643. Had been paying $25.

JFC I am annoyed by this and the greed of BCBS. I do not understand how an insurance company can justify this price change. It's criminal. I just started Wegovy last month. I'm not entirely sure what to do now. What are the chances of getting a Tier exception?

It's health insurance -- not subsidized health care. It isn't remotely "criminal."

DP. I think it's short sighted, though. They are saving a fortune on weight-related cardiac issues, joint surgeries, other prescriptions to manage cholesterol, etc. I bet it's in their long term interest to encourage GLP-1 use.

That said, surely Novo Nordisk has more than made back their money by now? At some point won't they drop the price?

[Anonymous]

I just saw a video on this that it’s the pharmaceutical company that’s overcharging the insurance companies. I have a feeling no insurance companies are going to be covering these meds until they can negotiate better prices. https://www.instagram.com/reel/DEa27d0y-QT/?igsh=MTBvMnJlMWJyanQ2dw==

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:My first fill for 2025 is at CVS and estimated at $643. Had been paying $25.

JFC I am annoyed by this and the greed of BCBS. I do not understand how an insurance company can justify this price change. It's criminal. I just started Wegovy last month. I'm not entirely sure what to do now. What are the chances of getting a Tier exception?

It's health insurance -- not subsidized health care. It isn't remotely "criminal."

DP. I think it's short sighted, though. They are saving a fortune on weight-related cardiac issues, joint surgeries, other prescriptions to manage cholesterol, etc. I bet it's in their long term interest to encourage GLP-1 use.

That said, surely Novo Nordisk has more than made back their money by now? At some point won't they drop the price?

I will assure you they have done the math on this.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:My first fill for 2025 is at CVS and estimated at $643. Had been paying $25.

JFC I am annoyed by this and the greed of BCBS. I do not understand how an insurance company can justify this price change. It's criminal. I just started Wegovy last month. I'm not entirely sure what to do now. What are the chances of getting a Tier exception?

It's health insurance -- not subsidized health care. It isn't remotely "criminal."

DP. I think it's short sighted, though. They are saving a fortune on weight-related cardiac issues, joint surgeries, other prescriptions to manage cholesterol, etc. I bet it's in their long term interest to encourage GLP-1 use.

That said, surely Novo Nordisk has more than made back their money by now? At some point won't they drop the price?

"Made back their money"? They aren't in the business of simply making back any money they have invested, lol. They are in the business of making as much money as possible.

Yeah, they'll drop the price. But only when new comparable drugs hit the market and create competition and drive the price down (will probably happen within the next 2 years or so -- more GLP-1 drugs are in development).

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:My first fill for 2025 is at CVS and estimated at $643. Had been paying $25.

JFC I am annoyed by this and the greed of BCBS. I do not understand how an insurance company can justify this price change. It's criminal. I just started Wegovy last month. I'm not entirely sure what to do now. What are the chances of getting a Tier exception?

It's health insurance -- not subsidized health care. It isn't remotely "criminal."

DP. I think it's short sighted, though. They are saving a fortune on weight-related cardiac issues, joint surgeries, other prescriptions to manage cholesterol, etc. I bet it's in their long term interest to encourage GLP-1 use.

That said, surely Novo Nordisk has more than made back their money by now? At some point won't they drop the price?

I will assure you they have done the math on this.

I bet they haven't, and that actually it's more a function of how people are paid and incentivized. The meds cost money this year and the "if not for the meds" heart attacks would come next year or in 10 years. If you are trying to show profit this year you don't care about the long term overall costs (let alone anyone's health).

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:My first fill for 2025 is at CVS and estimated at $643. Had been paying $25.

JFC I am annoyed by this and the greed of BCBS. I do not understand how an insurance company can justify this price change. It's criminal. I just started Wegovy last month. I'm not entirely sure what to do now. What are the chances of getting a Tier exception?

It's health insurance -- not subsidized health care. It isn't remotely "criminal."

DP. I think it's short sighted, though. They are saving a fortune on weight-related cardiac issues, joint surgeries, other prescriptions to manage cholesterol, etc. I bet it's in their long term interest to encourage GLP-1 use.

That said, surely Novo Nordisk has more than made back their money by now? At some point won't they drop the price?

I will assure you they have done the math on this.

I bet they haven't, and that actually it's more a function of how people are paid and incentivized. The meds cost money this year and the "if not for the meds" heart attacks would come next year or in 10 years. If you are trying to show profit this year you don't care about the long term overall costs (let alone anyone's health).

You think the insurance companies haven't done the math on this? Lol, ok.

The need to profit this year is part of that calculation. Not the whole of it.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:My first fill for 2025 is at CVS and estimated at $643. Had been paying $25.

JFC I am annoyed by this and the greed of BCBS. I do not understand how an insurance company can justify this price change. It's criminal. I just started Wegovy last month. I'm not entirely sure what to do now. What are the chances of getting a Tier exception?

It's health insurance -- not subsidized health care. It isn't remotely "criminal."

DP. I think it's short sighted, though. They are saving a fortune on weight-related cardiac issues, joint surgeries, other prescriptions to manage cholesterol, etc. I bet it's in their long term interest to encourage GLP-1 use.

That said, surely Novo Nordisk has more than made back their money by now? At some point won't they drop the price?

I will assure you they have done the math on this.

I bet they haven't, and that actually it's more a function of how people are paid and incentivized. The meds cost money this year and the "if not for the meds" heart attacks would come next year or in 10 years. If you are trying to show profit this year you don't care about the long term overall costs (let alone anyone's health).

You think the insurance companies haven't done the math on this? Lol, ok.

The need to profit this year is part of that calculation. Not the whole of it.

Agree. I’m sure they have done the math but it is also a function of the drugs being ridiculously overpriced and paid out NOW vs the long term savings only happen if people stay with that plan many years in the future. Given job and plan changes the latter is no guarantee.

[Anonymous]

I just found this out today, I just went to CVS and from $25.00 now it's $644.00, they said that is 50%. I called up FEP BCBS and they said Manufacturing prices had gone up.
I was told to get back to tier 2, I have to take other pills and if they don't work, then my doctor can submit a letter to the insurance asking to reduce the price back down.
This is bullshit after what I am paying for insurance. Time to go and make some noise with CONGRESS! I GUESS I DON'T TAKE ANYTHING! I SHOULD JUST GIVE UP MY INSURANCE
AND N'T TAKE ANY MEDS!

[Anonymous]

Anonymous wrote:I just found this out today, I just went to CVS and from $25.00 now it's $644.00, they said that is 50%. I called up FEP BCBS and they said Manufacturing prices had gone up.
I was told to get back to tier 2, I have to take other pills and if they don't work, then my doctor can submit a letter to the insurance asking to reduce the price back down.
This is bullshit after what I am paying for insurance. Time to go and make some noise with CONGRESS! I GUESS I DON'T TAKE ANYTHING! I SHOULD JUST GIVE UP MY INSURANCE
AND N'T TAKE ANY MEDS!

I have FEP BCBS, and I have gotten two letters from them informing me that it was moving to Tier 3, and the price would increase. It sucks, but they did actually notify people.

[Anonymous]

Anonymous wrote:I just found this out today, I just went to CVS and from $25.00 now it's $644.00, they said that is 50%. I called up FEP BCBS and they said Manufacturing prices had gone up.
I was told to get back to tier 2, I have to take other pills and if they don't work, then my doctor can submit a letter to the insurance asking to reduce the price back down.
This is bullshit after what I am paying for insurance. Time to go and make some noise with CONGRESS! I GUESS I DON'T TAKE ANYTHING! I SHOULD JUST GIVE UP MY INSURANCE
AND N'T TAKE ANY MEDS!

FEP Basic or Standard? If Standard you could ask CAremark to do a cost override to get the mail-in price.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I just found this out today, I just went to CVS and from $25.00 now it's $644.00, they said that is 50%. I called up FEP BCBS and they said Manufacturing prices had gone up.
I was told to get back to tier 2, I have to take other pills and if they don't work, then my doctor can submit a letter to the insurance asking to reduce the price back down.
This is bullshit after what I am paying for insurance. Time to go and make some noise with CONGRESS! I GUESS I DON'T TAKE ANYTHING! I SHOULD JUST GIVE UP MY INSURANCE
AND N'T TAKE ANY MEDS!

FEP Basic or Standard? If Standard you could ask CAremark to do a cost override to get the mail-in price.

Not the PP but I have standard. How do you request the cost override? Thanks!

[Anonymous]

I got a tier exception! My doctor filed a request for a tier exception yesterday, and it was granted today. So I'll be continuing to pay Tier 2 prices this year even though it has moved to Tier 3.

[Anonymous]

I'm really curious how many people left BCBS over this (I did) and whether it's more or less than they expected. They obviously knew, and intended, that people would.