semaglutide thru Fed BCBS

[Anonymous]

Does anyone know if Federal BCBS covers semaglutide injection? I am pre-diabetes and doctor would like me to lose like 30 lbs.
And anyone has a good recommendation doctor/practice/weight loss center to get it as well? Thanks

[Anonymous]

The insurance doesn't seem like an anonymous message board type of question. You need to call. No one knows your benefits.

Your primary care doctor should have prescribed when they suggested you lose 30 pounds. Any reason they didn't?

[Anonymous]

I'm pretty sure you need a type 2 diabetes diagnosis, not just pre-diabetes. Which is where the hang up is for many people.

[Anonymous]

I have Fed BCBS and am getting it covered without a diabetes diagnosis. I am going through Calibrate, which I realize a lot of people have problems with but so far they have handled the insurance for me. (That said, I need to call to check on my next Rx delivery.) When I started in March. I had a BMI of 32 and blood work indicating pre diabetes.

I have an appointment later this summer with Inova Weight Loss clinic, which I'd like to switch to. But they book months and months out, and Calibrate was a way to get started sooner. You could look into WW or other programs that are prescribing now.

[Anonymous]

I am covered with bcbs fed but my starting bmi was over 40.

[Anonymous]

check your formulary. All federal plans are required to cover obesity drugs now if you meet the criteria. Wegovy is the only one officially prescribed for obesity. YMMV on whether you could get Ozempic since you are pre-diabetic. Mounjaro seems to be very hard to get - requires prior authorization.

[Anonymous]

Mine is covered but I am diabetic.

[Anonymous]

Yes. I have BCBS Basic and it is covered. $25 copay. I do not have diabetes or pre-diabetes. There is no pre-authorization required.

[Anonymous]

I have BCBS FEP Basic. I've been on Wegovy for about 3 months. I had to meet these prior authorization qualifications https://info.caremark.com/content/dam/enterprise/caremark/microsites/dig/pdfs/pa-fep/fep-criteria/FEP_Criteria_Wegovy.pdf

I met the criteria by meeting the BMI qualifications (by a lot) AND having hypertension. I've used the wegovy coupon online and have not had any co-pay (like $0). yay! https://www.wegovy.com/coverage-and-savings/save-on-wegovy.html. I've used this coupon at CVS and Harris teeter.

Just FYI, a few of these variations of meds are a bit difficult to find b/c they're on the FDA shortage list (https://www.fda.gov/drugs/drug-safety-and-availability/drug-shortages). Some are easier to find than others. Be ready to call around A LOT to find Wegovy. Hopefully, it will be better in September per the manuf site, but we'll see.

I just went to my regular internal med dr. for the rx. She gave me a starter dose of the meds. We talked A LOT about the of side effects and weighed the pros and cons.

[Anonymous]

Anonymous wrote:The insurance doesn't seem like an anonymous message board type of question. You need to call. No one knows your benefits.

NP. Totally disagree. A lot of us have this insurance

[Anonymous]

Again….Wegovy is for weight loss and FEP CVS Caremark mail order prescription covers it.
I was originally on Ozempic and it was covered under FEP. Found out my Dr put in a pre-diabetes code to get it. The problem came in trying to get doctors office to send pre approval
If you are getting Ozempic covered you might want to look into why. I am OK with the pre diabetes diagnosis to get it covered.

[Anonymous]

BCBS has an app where all that information is listed. Perhaps go online and research for yourself???

[Anonymous]

Anonymous wrote:The insurance doesn't seem like an anonymous message board type of question. You need to call. No one knows your benefits.

Your primary care doctor should have prescribed when they suggested you lose 30 pounds. Any reason they didn't?

Her primary care doctor probably told her there is a shortage and to do something like metformin, but op just wants the diabetes injections, so she’s going doctor shopping.

[Anonymous]

Anonymous wrote:BCBS has an app where all that information is listed. Perhaps go online and research for yourself???

NP. Even if it's on the formulary, they might not cover. That's why people ask here to get other people's experiences.

[Anonymous]

Anonymous wrote:Yes. I have BCBS Basic and it is covered. $25 copay. I do not have diabetes or pre-diabetes. There is no pre-authorization required.

Not for long, a lot of BCBS just changed their formulary to cut off non diabetics using diabetic medication. Post back in July……