FEHB and Wegovy

[Anonymous]

In 2025 WeGovy will now cost $650 out of pocket on FEP Basic; it will now be a tier 3 drug instead of tier 2. There is a mail-in price that is $125 but i understand its not getable.

https://www.fepblue.org/pilot/rx-cost-tool/results

Ive never not had BCBS as a Fed but open to jumping this Open Season. Has anyone figured out other insurance providers with more affordable Wegovy costs? I am 40s, but obese. I have lost a bunch of weight since last December on Wegovy. I still have 25 to lose before I am no longer obese.

[Anonymous]

You can get a coupon on the Wegovy site that is good for 13 uses/months that brings the price to $650, which is about half off.

Hang on. Rereading your post -- why are you paying out of pocket if you're obese? I pay out of pocket because I'm no longer obese (because of the Wegovy!) so insurance stopped covering. But when my insurance (GEHA) was paying, the cost was negligible, like $20.

[Anonymous]

Anonymous wrote:You can get a coupon on the Wegovy site that is good for 13 uses/months that brings the price to $650, which is about half off.

Hang on. Rereading your post -- why are you paying out of pocket if you're obese? I pay out of pocket because I'm no longer obese (because of the Wegovy!) so insurance stopped covering. But when my insurance (GEHA) was paying, the cost was negligible, like $20.

OP has BCBS Basic (as do I). For 2025, BCBS is moving Wegovy from a tier 2 to a tier 3 drug in their formulary, which significantly increases the cost across all of their plans. So a lot of us are looking at moving to a different insurer.

OP, I'll shop around but it looks like the cost under BCBS Standard with mail order is not too bad. BCBS Basic is definitely the worst price.

[Anonymous]

I switched from BCBS to GEHA last year for other reasons. I'm on Wegovy and have been paying $25/month with the coupon. Looking at the GEHA 2025 brochure, it looks like GEHA's price for Wegovy is going to be a lot better than BCBS. For GEHA standard the member portion for preferred drugs is 40% of the allowance, but is capped at $250 (and for non-preferred it's 60%, capped at $350). This is from section 5f of this:

https://www.geha.com/~/media93/Project/GEHA/GEHA/documents-files/medical/2025/fehb/2025-geha-fehb-high-and-standard-options-medical-plan-brochure.pdf

[Anonymous]

I need to find different insurance than BCBS basic due to Wegovy but many of our mental health providers only seem to take BCBS. Does GEHA have their own network or use someone else's?

Has anybody heard whether BCBS Standard will actually fill Wegovy by mail order? They had stop shipping it back in May. It seems to me if it's supposed to be available Mail order but the mail order company isn't shipping a particular drug, BCBS shuld let you get that drug at the same price from a regular pharmacy.

[Anonymous]

Fed here with BCBS Basic.

Is this a final determination?

I work in healthcare myself and have worked with a handful of patients who had really, really severe reactions to compounded GLP-1 agonists. Like, year-long adverse effects. If I was ever interested in compounded, that's definitely off the table now.

[Anonymous]

Anonymous wrote:I need to find different insurance than BCBS basic due to Wegovy but many of our mental health providers only seem to take BCBS. Does GEHA have their own network or use someone else's?

Has anybody heard whether BCBS Standard will actually fill Wegovy by mail order? They had stop shipping it back in May. It seems to me if it's supposed to be available Mail order but the mail order company isn't shipping a particular drug, BCBS shuld let you get that drug at the same price from a regular pharmacy.

GEHA uses the United network.

FWIW we use out of network providers for mental health. GEHA's reimbursement is way better than BCBS Standard for OON.

[Anonymous]

Anonymous wrote:I need to find different insurance than BCBS basic due to Wegovy but many of our mental health providers only seem to take BCBS. Does GEHA have their own network or use someone else's?

Has anybody heard whether BCBS Standard will actually fill Wegovy by mail order? They had stop shipping it back in May. It seems to me if it's supposed to be available Mail order but the mail order company isn't shipping a particular drug, BCBS shuld let you get that drug at the same price from a regular pharmacy.

GEHA uses United Health Care Choice Plus PPO as its network. And they reimburse OON mental health MUCH more generously than BCBS does.

[Anonymous]

Anonymous wrote:

Anonymous wrote:You can get a coupon on the Wegovy site that is good for 13 uses/months that brings the price to $650, which is about half off.

Hang on. Rereading your post -- why are you paying out of pocket if you're obese? I pay out of pocket because I'm no longer obese (because of the Wegovy!) so insurance stopped covering. But when my insurance (GEHA) was paying, the cost was negligible, like $20.

OP has BCBS Basic (as do I). For 2025, BCBS is moving Wegovy from a tier 2 to a tier 3 drug in their formulary, which significantly increases the cost across all of their plans. So a lot of us are looking at moving to a different insurer.

OP, I'll shop around but it looks like the cost under BCBS Standard with mail order is not too bad. BCBS Basic is definitely the worst price.

FEP BCBS Standard does not do Wegovy via mail order anymore. Unfortunately.

[Anonymous]

Anonymous wrote:I need to find different insurance than BCBS basic due to Wegovy but many of our mental health providers only seem to take BCBS. Does GEHA have their own network or use someone else's?

Has anybody heard whether BCBS Standard will actually fill Wegovy by mail order? They had stop shipping it back in May. It seems to me if it's supposed to be available Mail order but the mail order company isn't shipping a particular drug, BCBS shuld let you get that drug at the same price from a regular pharmacy.

They are not going to fill it by mail order.

[Anonymous]

Anonymous wrote:Fed here with BCBS Basic.

Is this a final determination?

I work in healthcare myself and have worked with a handful of patients who had really, really severe reactions to compounded GLP-1 agonists. Like, year-long adverse effects. If I was ever interested in compounded, that's definitely off the table now.

My doctor literally will not prescribe to a compounding pharmacy for safety reasons.

[Anonymous]

Is anyone complaining about this to the powers that be? The federal government has good bargaining power and this is BS.

[Anonymous]

I have FEP BCBS standard and I used to use the mail order pharmacy but they stoped carrying Wegovy. Now I pick it up at CVS and its cheaper for me. I have lost 40 pounds and am now a normal weight. My doctor has required video check ins. Will my prescription end when I actually go to the doctor and weigh in?

[Anonymous]

We have fep BCBS standard, and I have been on Wegovy since April and have lost about 35 pounds. I have plenty more to go.

I've looked closely at this and given it a lot of thought. We are sticking with BCBS standard. Even though the out-of-pocket costs for my Wegovy will go up I'm not convinced -- given all facts and circumstances for us, including our other healthcare costs and coverage for them and the fact that costs for Wegovy are not going to be that much lower with other carriers -- that it makes sense for us to change. YMMV.

[Anonymous]

Anonymous wrote:Is anyone complaining about this to the powers that be? The federal government has good bargaining power and this is BS.

This is not BCBS's decision. The plan is a government plan. This is a government cost-cutting decision. We are actually lucky to have Wegovy covered at all -- most folks with insurance through their jobs are finding GLP-1s are no longer covered at all for 2025.