GLP1 coverage on federal health insurance

[Anonymous]

Anyone have their GLP1 covered by a federal health insurance plan?

[Anonymous]

Fedblue basic
Zip bound - not covered
Ozempic - covered

[Anonymous]

Anonymous wrote:Fedblue basic
Zip bound - not covered
Ozempic - covered

OP here: I have Fedblue Basic so that's why I posted. I'm really looking for a plan that covers Zepbound.

[Anonymous]

CareFirst has ozempic.

[Anonymous]

Anonymous wrote:CareFirst has ozempic.

"CareFirst" is not insurance. It's a PBM.

[Anonymous]

I have BCBS fep standard, and my Wegovy is covered, but I have a tier exception and still pay a decent amount in co-insurance myself.

[Anonymous]

I have BCBS FEP basic and went rounds and rounds of back and forth between my DR and BCBS to get on a GLP1. When they finally approved Wegovy, I went to pick it up only to discover my cost with insurance was more than double what it would cost to self pay direct from the drug maker for the Zepbound I actually wanted. SO I left it there. Now trying one more time to get my Dr to send Rx to Lilly direct. And if that doesn't work, I'm going to give up on trying to do this "the right way" and just go through an online provider/Rx self pay

[Anonymous]

I have BCBS FedBlue standard, and neither Zepbound nor Ozempic is covered now.

Ozempic was covered when I took it in 2023 without pre-authorization, but then they changed it starting Jan 2024, and it wasn't, and I got off. I didn't really lose weight on it.

I wanted (maybe needed) to go on a GLP-1 starting in October 2025 because I was on a steroid medication that was making me gain weight rapidly. My BMI was in the "overweight" category, but not obese. I had no other comorbidities (like high A1C, high blood pressure, sleep apnea), and despite the medical condition I needed to take steroids for, FedBlue would not cover Ozempic or Zepbound. I pay out of pocket ($449 per month) for Zepbound through Lilly. It's working though! I've lost 22lbs in 4.5 months.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Fedblue basic
Zip bound - not covered
Ozempic - covered

OP here: I have Fedblue Basic so that's why I posted. I'm really looking for a plan that covers Zepbound.

Fed insurance here and they pulled coverage for zepbound. They only barely cover wegovy and one other which is a daily injectable but cheap. I was on wegovy and it gave me horrible migraines and barely moved the needle on weigh. I was finally making progress on zepbound and then they pulled coverage. I am looking into doing compounded zepbound.

[Anonymous]

I have some coverage on BCBS Standard for Wegovy. My coinsurance is a lot, though.

[Anonymous]

BCBS Federal Retiree Plan: It's cheaper to buy it direct from Eli Lilly. The coverage is a joke.

[Anonymous]

Anonymous wrote:Fedblue basic
Zip bound - not covered
Ozempic - covered

I have that plan and it was not covered, and I got a letter saying they would not cover it until I had three a couple other drugs, all of which were essential speed. That is insane because I have tachycardia!

[Anonymous]

Ugh typos: I had to try a couple of other drugs, which were all essentially speed (ephinephries) first.

And I have sleep apnea, HBP and the tachycardia.

[Anonymous]

Anonymous wrote:BCBS Federal Retiree Plan: It's cheaper to buy it direct from Eli Lilly. The coverage is a joke.

Ridiculous isn't it? Not retired here yet but we pay close to 30K/yr for our family with BCBS FEP and they are covering less and charging more for basics.

[Anonymous]

Yes, BCBS FEP standard covers my Wegovy (to a certain extent) but not Zep.