BCBS Federal Employee Program- Basic Tier- which weighloss med?

[Anonymous]

I did my initial intake/ blood work with my PCP this past week and have an appointment next week to go over the results and get a prescription for weight loss drugs and/or start the prior approval process.

I understand that there was a change with the BCBS FEP Standard Tier recently so specifically asking about basic. What do people pay for what? Is one med better than the other a marginally more expensive? What should I be asking and advocating for?

I see what my insurance plan says but I keep seeing other discounts, cards...

I've come to terms with paying out of pocket or a high price until I can switch plans in 2026.

Thank you!

[Anonymous]

wegovy

[Anonymous]

I have BCBS basic and wegovy is cheaper (499) self pay vs coverage (545). It's insane. I think ozempic is cheaper but you'll need a diabetes diagnosis for it. Not sure on Mounjaro or Zepbound.

[Anonymous]

Anonymous wrote:wegovy

This.

[Anonymous]

BCBS actually won't approve Zep first. Wegovy also costs less than Zep.

I'm on Zep and the side effects are wayyyyyy better than Wegovy.

Good Luck.

[Anonymous]

I have Zep “covered” by Basic, and get it for about 475 bucks. I had to appeal a denial, and show that I need it for sleep apnea, and cannot take the other weight loss drugs on the formulary. Wegovy made me super constipated and is more expensive. The stupidity of not covering Zep when it’s cheaper, more effective, and FDA approved for use in sleep apnea patients, is something. Looking forward to open season.

[Anonymous]

Anonymous wrote:I have Zep “covered” by Basic, and get it for about 475 bucks. I had to appeal a denial, and show that I need it for sleep apnea, and cannot take the other weight loss drugs on the formulary. Wegovy made me super constipated and is more expensive. The stupidity of not covering Zep when it’s cheaper, more effective, and FDA approved for use in sleep apnea patients, is something. Looking forward to open season.

Sorry that is 375, not 475. Still too expensive. If I’d waited long enough to get diagnosed with diabetes, it would be 25 dollars. Perverse.

[Anonymous]

Why not take that prescription and just go to compounded? It should be $200-300.

And no, that's not too expensive. Just wait until you see the reduction in food purchases, restaurant meals, no alcohol, no Starbucks. You're actually saving money by being on it even if you pay $300.

[Anonymous]

Anonymous wrote:Why not take that prescription and just go to compounded? It should be $200-300.

And no, that's not too expensive. Just wait until you see the reduction in food purchases, restaurant meals, no alcohol, no Starbucks. You're actually saving money by being on it even if you pay $300.

I like the pens, and I don’t trust the compounded formulas.

[Anonymous]

Your doc can do a tier exception and it’s $25.

[Anonymous]

I left Federal BCBS over their price hike for Wegovy and now have one of the Aetna programs instead. I expected to pay $60, I think? but in reality I have never been charged at all - I think the pharmacy does some coupon magic.

[Anonymous]

I have BCBS (can't remember basic or standard). DH pays $0 for Zepbound, and I pay $375. Not sure why we are different. He was required to start with Wegovy first, but I wasn't.