Wegovy moving Tiers on BCBS FEP
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Anonymous
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Just checked on my pre-authorization for Wegovy. I have BCBS FEP Basic. The customer service person said that Wegovy is moving from Tier 2 to Tier 3 for 2025 (as of right now). That means a SIGNIFICANT out-of-pocket expense now. The savings coupon is only for 13 boxes of pens I think.
Be sure to check your rx's for open enrollment for 2025. I may have to switch plans to GEHA Elevate Plus or something else. |
Anonymous
| What is the price difference? I pay $24.99 with coupon now, and I think it would be $60 withiut coupon. How much will it be in 2025? |
Anonymous
Hard to say for sure. But I have BCBS Fep Standard, and my Wegovy is moved from a Tier 2 to a Tier 3 drug, and will require 50% coinsurance. I'm not sure what that means ... because I will be responsible for 50% of ... what price? The retail price? Or a price negotiated by BCBS? I think someone posted on another forum somewhere that their eob had it listed at like $1300. So if that is the amount (which is a big if), then I'd be responsible for $650 per month in 2025. The coupon, which has brought it down to $24.99 for me as well, is not only limited to 13 fills, it is also limited in amount of savings -- specifically $225. So, subtract $225 from $650, and my out-of-pocket per month would be $425 per month in 2025. But in order to get the 50% coinsurance from BCBS, I would have to go to a preferred pharmacy, which I haven't been doing because the coupon got it down to $24.99 no matter where I went ... so I have been going to Costco because they had it. So now I won't be able to do that. So that is a wrinkle (although this week, for the first time, Costco didn't have it either). Bottom line for most of us regarding how much our Wegovy will cost in 2025 with FEP BCBS -- a lot more. |
Anonymous
| This is not good for me. I have BCBS Blue Focus. I may end up changing to something else (I'll be in the new postal service plans). |
Anonymous
| Is there any equivalent drug on the formulary for next year? |
Anonymous
| Will this switch affect FEP Standard as well? |
Anonymous
Yes, moving to Tier 3 on both. |
Anonymous
| I'm looking at the GEHA website , this is a dealbreaker for me and bcbs. |
Anonymous
So it moves from the insured paying 30% to the insured paying 50%? I currently pay $24.99/month, so it won’t be that much more. Or am I missing something? |
Anonymous
You are probably still on the coupon, which only lasts for 13 fills. After that, it will cost $500-600/month even with insurance. |
Anonymous
| Does anyone know of any plan that can be purchased on the DC Exchange that would cover Wegovy? |
Anonymous
| I’ve been on Wegovy for 18 months. It has always been $25, which suggests to me that the coupon is not limited to 13 months? |
Anonymous
same. no idea if it is my insurance (fed bc standard), the coupon, or both |
Anonymous
| Where can I check GEHA's 2025 prices? I'm on zepbound and pay $250 but have a prior auth that is expiring. Ugh! |
Anonymous
No. |