semaglutide thru Fed BCBS

[Anonymous]

Anonymous wrote:

Anonymous wrote:The insurance doesn't seem like an anonymous message board type of question. You need to call. No one knows your benefits.

Your primary care doctor should have prescribed when they suggested you lose 30 pounds. Any reason they didn't?

Her primary care doctor probably told her there is a shortage and to do something like metformin, but op just wants the diabetes injections, so she’s going doctor shopping.

Metformin isn't indicated for weight loss.

[Anonymous]

Anonymous wrote:

Anonymous wrote:The insurance doesn't seem like an anonymous message board type of question. You need to call. No one knows your benefits.

Your primary care doctor should have prescribed when they suggested you lose 30 pounds. Any reason they didn't?

Her primary care doctor probably told her there is a shortage and to do something like metformin, but op just wants the diabetes injections, so she’s going doctor shopping.

"Doctor shopping" = find a doctor who knows about it. I'm a PP who is getting it, and my primary care doc will not prescribe because she is not familiar with it; she sent me to a specialist. GPs don't just write scripts for anything.

Also, I tried metformin first and could not tolerate it. Believe me, I'd love to be on an easy cheap pill.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:The insurance doesn't seem like an anonymous message board type of question. You need to call. No one knows your benefits.

Your primary care doctor should have prescribed when they suggested you lose 30 pounds. Any reason they didn't?

Her primary care doctor probably told her there is a shortage and to do something like metformin, but op just wants the diabetes injections, so she’s going doctor shopping.

Metformin isn't indicated for weight loss.

Exactly, op was talking about her prediabetes and her doctor was probably like uhhh huhhh and didn’t prescribe ozempic or Mounjaro.

[Anonymous]

i had gestational diabetes so BCBS and my pharmacy both still have me marked as diabetic years later. I'm fine with that since that meant i could get my pneumonia vax and ozempic with no issues. need to line up shingles next.

[Anonymous]

I got my Wagovy (for weight loss) Rx from my cardiologist.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Yes. I have BCBS Basic and it is covered. $25 copay. I do not have diabetes or pre-diabetes. There is no pre-authorization required.

Not for long, a lot of BCBS just changed their formulary to cut off non diabetics using diabetic medication. Post back in July……

Federal BCBS can’t change in July. They are locked into their contract with federal employees for all of 2023. And the GLP-1s like Wegovy are covered in both the basic and standard formularies in 2023 for BMI 27 plus co-morbid condition or BMI 30. Needs a PA. Original one is about six months and you need to lose 5% of body weight to get a second PA. Must be used in conjunction with a diet and exercise.

During 2024 Fed Open season, check the formularies carefully if weight loss meds are important to you.

I use NOVA Physicians Wellness Center and am pleased. But it’s not a get a prescription and see you in 6 months thing. You weigh in, see the PA and see a dietician every 2 weeks at first if you are on meds, while you titration up.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Yes. I have BCBS Basic and it is covered. $25 copay. I do not have diabetes or pre-diabetes. There is no pre-authorization required.

Not for long, a lot of BCBS just changed their formulary to cut off non diabetics using diabetic medication. Post back in July……

Federal BCBS can’t change in July. They are locked into their contract with federal employees for all of 2023. And the GLP-1s like Wegovy are covered in both the basic and standard formularies in 2023 for BMI 27 plus co-morbid condition or BMI 30. Needs a PA. Original one is about six months and you need to lose 5% of body weight to get a second PA. Must be used in conjunction with a diet and exercise.

During 2024 Fed Open season, check the formularies carefully if weight loss meds are important to you.

I use NOVA Physicians Wellness Center and am pleased. But it’s not a get a prescription and see you in 6 months thing. You weigh in, see the PA and see a dietician every 2 weeks at first if you are on meds, while you titration up.

This 1000000% I think in the many many years I've had BCBS I've only seen them do a change once in coverage mid-year. That was during COVID when the White House mandated all medical plans to cover COVID tests. Also, I think it's the BCBS Standard plan that allows you to use their Mailorder pharmacy. Not Basic. It's only if you have medicare part B and something else, but I can't remember can you use mailorder with BCBS FEP Basic.

[Anonymous]

Anonymous wrote:Yes. I have BCBS Basic and it is covered. $25 copay. I do not have diabetes or pre-diabetes. There is no pre-authorization required.

How did you get this approve?

[Anonymous]

Anonymous wrote:

Anonymous wrote:Yes. I have BCBS Basic and it is covered. $25 copay. I do not have diabetes or pre-diabetes. There is no pre-authorization required.

How did you get this approve?

There’s no approval required

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Yes. I have BCBS Basic and it is covered. $25 copay. I do not have diabetes or pre-diabetes. There is no pre-authorization required.

Not for long, a lot of BCBS just changed their formulary to cut off non diabetics using diabetic medication. Post back in July……

Federal BCBS can’t change in July. They are locked into their contract with federal employees for all of 2023. And the GLP-1s like Wegovy are covered in both the basic and standard formularies in 2023 for BMI 27 plus co-morbid condition or BMI 30. Needs a PA. Original one is about six months and you need to lose 5% of body weight to get a second PA. Must be used in conjunction with a diet and exercise.

During 2024 Fed Open season, check the formularies carefully if weight loss meds are important to you.

I use NOVA Physicians Wellness Center and am pleased. But it’s not a get a prescription and see you in 6 months thing. You weigh in, see the PA and see a dietician every 2 weeks at first if you are on meds, while you titration up.

I could have written this same post (down to going to NOVA Physicians Wellness - maybe I'll see you in the waiting room some day! ) and agree. My BMI was 31 and prediabetic and BCBS fed so far has covered Wegovy and, when that was in short supply, now Ozempic.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Yes. I have BCBS Basic and it is covered. $25 copay. I do not have diabetes or pre-diabetes. There is no pre-authorization required.

k

How did you get this approve?

There’s no approval required

Not true. Pre approval is required.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Yes. I have BCBS Basic and it is covered. $25 copay. I do not have diabetes or pre-diabetes. There is no pre-authorization required.

k

How did you get this approve?

There’s no approval required

Not true. Pre approval is required.

Okay well it wasn’t for me. I guess my BCBS Basic is different.

[Anonymous]

Yes, BCBS FEP will cover it. Mail order pharmacy is the least expensive.