Feds - Have you looked into Zepbound coverage?

[Anonymous]

I have GEHA standard and it is listed at $300 with prior authorization required. Wegovy, Mounjaro and Ozempic are $200 each so not sure why the price difference.

Has anyone looked into their plan's coverage? Now that it is open enrollment, I'm debating changing plans though I did finally get prior auth for Mounjaro (not T2) so might be worth sticking with GEHA.

[Anonymous]

There is a manufacturer's coupon that makes it $25/month for a year if you have insurance coverage.

[Anonymous]

Ozempic costs $40 per month with my fed Blue Cross.

[Anonymous]

Anonymous wrote:Ozempic costs $40 per month with my fed Blue Cross.

Can you check your formulary to see what Zepbound costs? It should have been added by now.

[Anonymous]

Anonymous wrote:Ozempic costs $40 per month with my fed Blue Cross.

But Fed BCBS only covers Ozempic for T2. Wegovy is for weight loss it’s a tier 2 drug (high cost sharing ) for standard, but you can get 3 months for $90 mail order. Zepbound is lin the formulary, but the prices aren’t loading yet. I called and asked and they said coverage determinations would be made in time for the next formulary revision on 1/1. Not helpful for open season.

[Anonymous]

GEHA now requires prior authorization for Ozempic, so is aligned with almost all other Fed plans. if you got prior authorization for Mounjaro, i'd stay the course, frankly.

[Anonymous]

Wegovy is nowhere to be found so I tried for a prior authorization for Zepbound with BCBS and it was denied. They said they didn’t cover it. So basically I’m stuck. Very frustrating.

[Anonymous]

I have BCBS FEP, I don't see zepbound at all. Maybe it'll be there in Jan 2024?

https://www.fepblue.org/-/media/PDFs/Medical%20Policies/Jan-2023-Pharm-New/5_99_027%20Weight%20Loss%20Medications.pdf

I saw this thread on reddit...
https://www.reddit.com/r/Mounjaro/comments/17rituh/federal_bcbs_and_zepbound/

[Anonymous]

I'm impatiently waiting them to deny covering it so I can use the savings card and our HSA and start the dang drug. It's almost been a week. Does it usually take this long for them to "check"?

[Anonymous]

Anonymous wrote:I'm impatiently waiting them to deny covering it so I can use the savings card and our HSA and start the dang drug. It's almost been a week. Does it usually take this long for them to "check"?

They went back to my Primary that I needed to try 3 pills first. Nope. Not with those crazy side effects and needing to be weened off. No thank you.

[Anonymous]

Did you try to appeal?

[Anonymous]

Anonymous wrote:

Anonymous wrote:I'm impatiently waiting them to deny covering it so I can use the savings card and our HSA and start the dang drug. It's almost been a week. Does it usually take this long for them to "check"?

They went back to my Primary that I needed to try 3 pills first. Nope. Not with those crazy side effects and needing to be weened off. No thank you.

Can you just pretend and tell the doctor you stopped because of side effects?

[Anonymous]

I think $100 gym membership stipend is better use of resources.

Wait for the 5 year long term use side effects to starting showing on all of these.

[Anonymous]

Anonymous wrote:I think $100 gym membership stipend is better use of resources.

Wait for the 5 year long term use side effects to starting showing on all of these.

What’s a $100 gym stipend? Is this a policy suggestion?

[Anonymous]

Anonymous wrote:

Anonymous wrote:I think $100 gym membership stipend is better use of resources.

Wait for the 5 year long term use side effects to starting showing on all of these.

What’s a $100 gym stipend? Is this a policy suggestion?

Pretty straightforward you would get up to $100/month to join a gym.
A lot of healthcare plans offer it.