Wegovy moving Tiers on BCBS FEP

[Anonymous]

Anonymous wrote:

Anonymous wrote: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.

I'm seeing folks on Reddit who left BCBS for MHBP -- and their requests for Wegovy prior authorization are getting denied. How has this worked out for you?

I'm the pp above who just got a tier exception for Wegovy on FEP BCBS standard, so right now I'm pretty happy I did not leave BCBS.

I have a PA in my MHBP file - it appeared there automatically after my change in enrollment. But I have not tried to fill an Rx yet under the new plan, so TBD.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote: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.

I'm seeing folks on Reddit who left BCBS for MHBP -- and their requests for Wegovy prior authorization are getting denied. How has this worked out for you?

I'm the pp above who just got a tier exception for Wegovy on FEP BCBS standard, so right now I'm pretty happy I did not leave BCBS.

I have a PA in my MHBP file - it appeared there automatically after my change in enrollment. But I have not tried to fill an Rx yet under the new plan, so TBD.

I hope it goes through fine!

[Anonymous]

Hey all. (I know we have bigger things on our minds right now w/ the new administration.)

I'm on Wegovy since last year. With the new year, they are increasing price - I'm ok with that. That said, they previously communicated it would be $125/month via mail-order.

I tried moving from CVS retail (now $643/mo) to CVS Caremark for a 3 months supply (which is $125/mo). Of course, CVS Caremark says they don't have stock and haven't in 6 months.

I'm willing to pay the $125/month copay but it seems horribly bait-and-switch to say "you must use CVS Caremark mail order" when it's been out of stock for months. We would have made a different choice at open enrollment if we knew it was going to be like this.

This seems like a way for them to say they are offering it but not really offer it.

With the popularity of BCBS FEP, has anyone else found way around this? (other than the tier exemptions?) Does the unavailability of CVS Caremark allow for us to get the $125 rate from CVS Retail? What's the magic here?

[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!

This was me. I got the novo nordisk coupon and it brought it down to 412.00 I paid for it but it will be the last month. I have it for cardiovascular issues but I also have standard medicines for that. It did help me trim down a bit which was nice.

[Anonymous]

Tried to pick up my Wegovy yesterday it went from 24.99 to 771.00 that's with BCBS federal coverage

[Anonymous]

Hi all I am BCBS Fed Employee Standard. Years ago I was on Ozempic, then insurance stopped covering and I moved to Mounjaro, and yet again insurance stopped covering. Wegovy was always covered but was unaffordable. Now the only thing covered is Wegovy. I saw the post about mail in pharmacy via Caremark (advertised price is $125 but it’s not available and hasn’t been for a long time due to shortages). I got nowhere with my insurance calls yesterday but today I called insurance help line first (not mail in pharmacy number that takes you straight to Caremark CVS). I complained over the fraud of advertising I could go to any local pharmacy (not just CVS Caremark) and get it for $125 when in practice the only option is CVS Caremark and they don’t provide it via mail. The rep I got agreed to transfer me over to CVS Caremark with her still on the phone—she basically escalated my complaint. The CVS Caremark person then did an override on my account—so I can go to my local pharmacy and get my Wegovy filled at the mail in price of $125. Also your doc can send in a prescription for 3 months and you fill it at that one time for $125 (same price whether you get 1-3 months so get 3 to bring cost down to old price!). I hope this helps others. I only knew to attempt this from what I read on here!

[Anonymous]

Otherwise the cost was $416 per month (that was after applying Wegovy manufacturing coupon which brings it down $225). I have no idea if coupon can be applied to my $125 but I can do $125 so if not still works for me. Try it, hope others can do something like this.

[Anonymous]

Anonymous wrote:Hey all. (I know we have bigger things on our minds right now w/ the new administration.)

I'm on Wegovy since last year. With the new year, they are increasing price - I'm ok with that. That said, they previously communicated it would be $125/month via mail-order.

I tried moving from CVS retail (now $643/mo) to CVS Caremark for a 3 months supply (which is $125/mo). Of course, CVS Caremark says they don't have stock and haven't in 6 months.

I'm willing to pay the $125/month copay but it seems horribly bait-and-switch to say "you must use CVS Caremark mail order" when it's been out of stock for months. We would have made a different choice at open enrollment if we knew it was going to be like this.

This seems like a way for them to say they are offering it but not really offer it.

With the popularity of BCBS FEP, has anyone else found way around this? (other than the tier exemptions?) Does the unavailability of CVS Caremark allow for us to get the $125 rate from CVS Retail? What's the magic here?

I'm really glad the PP got Caremark to honor the mail rx rate, I hope that works. I left BCBS because it was clear last year that the mail rx option was not happening in real life. I really think it's fraud that they displayed it during open season as if it would be an option.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Hey all. (I know we have bigger things on our minds right now w/ the new administration.)

I'm on Wegovy since last year. With the new year, they are increasing price - I'm ok with that. That said, they previously communicated it would be $125/month via mail-order.

I tried moving from CVS retail (now $643/mo) to CVS Caremark for a 3 months supply (which is $125/mo). Of course, CVS Caremark says they don't have stock and haven't in 6 months.

I'm willing to pay the $125/month copay but it seems horribly bait-and-switch to say "you must use CVS Caremark mail order" when it's been out of stock for months. We would have made a different choice at open enrollment if we knew it was going to be like this.

This seems like a way for them to say they are offering it but not really offer it.

With the popularity of BCBS FEP, has anyone else found way around this? (other than the tier exemptions?) Does the unavailability of CVS Caremark allow for us to get the $125 rate from CVS Retail? What's the magic here?

I'm really glad the PP got Caremark to honor the mail rx rate, I hope that works. I left BCBS because it was clear last year that the mail rx option was not happening in real life. I really think it's fraud that they displayed it during open season as if it would be an option.

Update: I will get my Wegovy for $0!!! I am still in shock and will go get it tomorrow morning. Thanks to persistence and this blog and my skill at firing off a gazillion written pleas and phone calls (hours!!!), I discovered that if your insurance plan advertises on your plan website after you login that your meds are available for $125 via its mail in pharmacy but you know that is a fraud as it has never been available or hasn’t been in forever (even without shortages), you can have your insurance company escalate your issue about false advertising to the mail in pharmacy provider—all with you in the phone—who will then do an override so you can get mail in pricing at your local pharmacy. So with that I can get 1-3 Wegovy pens filled at one time for just $125. And since I had already had my local pharmacy apply the manufacturer coupon to my account (removing up to $225 if your insurance covers the drug—which mine did but still left me with more than $400 per single pen), $125-225 equals ZERO!

[Anonymous]

I have BCBS Standard and called Caremark to request a cost override to honor the mail in price for in-store pick-up at CVS. I was expecting to pay $125 and somehow my Wegovy is $24.99. I don’t know what these people did but I’m not complaining!

[Anonymous]

Congratulations, so glad you went for mail in override and it worked for you too!

[Anonymous]

This is accurate. I requested an override and picked up Wegovy just a short while ago $24.99

[Anonymous]

Bcbs basic, I just got my tier override.

[Anonymous]

Anonymous wrote:Bcbs basic, I just got my tier override.

Did you argue you tried other drugs first, or did you do it by complaining about the mail order unavailability?

I applied for an override with BCBS basic and it was denied. I get Wegovy through a local pharmacy, not CVS, so I'm not sure that I can make the false advertising claim about mail order?

[Anonymous]

Not PP but I am original poster about getting mail delivery price at local pharmacy (now actually get from local for $0 as they also applied manufacture coupon to mail in price). I don’t use CVS. I have BCBS Standard. I recommend calling the number for BCBS Basic, complain about false advertising, and have the BCBS Basic customer service rep call CVS Caremark mail in pharmacy with you on phone. This should prompt CVS Caremark to submit an exception for you to get the mail in rate at your local pharmacy. You should also get coupon from drug website and have your local pharmacy apply that too.