Zepound finally hits FEP BCBS

[Anonymous]

Anonymous wrote:Yes friends, EVERY BCBS PLAN IS DIFFERENT BASED ON WHAT YOUR EMPLOYER NEGOTIATES WITH THE COMPANY. OP is talking about FEP only. DUH.

Go eat a cookie

[Anonymous]

it's not added to mail service at this time 2/21/2024. No date on when it will be but it is at the 474.13 cost right now if you ahve PA.

[Anonymous]

Anonymous wrote:it's not added to mail service at this time 2/21/2024. No date on when it will be but it is at the 474.13 cost right now if you ahve PA.

Mine is a bit over $350 under BCBS standard. Zepbound’s coupon will take $150 off the insurance price.

The big issue is that you have to try Wegovy and Saxenda before Zepbound. I had stalled on Wegovy, and had moved to Zepbound as soon as it was available. And had zero desire to stop what was working In order to check the Saxenda box. My PA went through the Saxenda prescribing information with me and we found a “prescribe with caution” or “may not be appropriate if…” condition documented in my medical history. So, she put in the PA that Saxenda was counter indicated because…. I was surprised it worked. But, I’m now approved through August.

Looking at pharmacy receipts, BCBS pays more in cost sharing for Wegovy than Zepbound. So, I’m not sure why they make it so much harder to get. My guess is that it’s because no one can get the lower doses of Wegovy to start and BCBS won’t count unavailability as a reason for not trying Wegovy first. Which reinforces the point that insurance companies suck.

I did pay OOP ($550) for two months waiting for BCBS to get it together and approve Zepbound. And was pleasantly surprised to see that they
Backdated the PA by one month. So, one of the fills is eligible for reimbursement by BCBS.

[Anonymous]

UnitedHealth is covering Zepbound for $100/month out of pocket. Just started it 3 weeks ago, and going to stick to the lowest dose again for this next 4 weeks.

I really like it. It's teaching me how to eat normal portions (many eating disorders & food insecurity in my past) and it's killing the cravings for snacks.

[Anonymous]

Hi guys my doctor sent PA to BCBS FEP I have the Basic plan. They rejected saying that I needed to try Wegovy and Saxenda first. I submitted a reconsideration stating that Wegovy had stopped working for me (been on it a year) and that I was scared to take Saxenda because of the thyroid issues in my family. They approved it! I was so excited! I then went into Zepbounds website and downloaded the savings coupon. I went to my pharmacy they filled it and my copay was $445.00 with the coupon. Crazy sauce!!! I cant pay that I thought it was going to be the same or similar to Wegovy once approved but no. Its not part of the tier drugs. That could change but for now I cannot pay that amount. Stinks since I was able to get the PA approval.

[Anonymous]

Anonymous wrote:UnitedHealth is covering Zepbound for $100/month out of pocket. Just started it 3 weeks ago, and going to stick to the lowest dose again for this next 4 weeks.

I really like it. It's teaching me how to eat normal portions (many eating disorders & food insecurity in my past) and it's killing the cravings for snacks.

+1

When I go out to eat with my thin friends I now eat about the same volume as them.

[Anonymous]

Anonymous wrote:

Anonymous wrote:UnitedHealth is covering Zepbound for $100/month out of pocket. Just started it 3 weeks ago, and going to stick to the lowest dose again for this next 4 weeks.

I really like it. It's teaching me how to eat normal portions (many eating disorders & food insecurity in my past) and it's killing the cravings for snacks.

+1

When I go out to eat with my thin friends I now eat about the same volume as them.

Are you on the federal United Healthcare plan? I tried it just about three weeks ago and they didn't give me the prior authorization. Wondering if I just missed it by days or if you're on a different UHC plan.

[Anonymous]

Anonymous wrote:UnitedHealth is covering Zepbound for $100/month out of pocket. Just started it 3 weeks ago, and going to stick to the lowest dose again for this next 4 weeks.

I really like it. It's teaching me how to eat normal portions (many eating disorders & food insecurity in my past) and it's killing the cravings for snacks.

I got stuck on their prior authorization. They wouldn't approve unless I'd tried Qsimia, which I don't want to do. Did they approve you without trying other drugs first? (Is this the FED plan?)

[Anonymous]

Just saw that they've moved Wegovy to Tier 3 (60% copay) instead of Tier 2 ($75 copay) for 2025, the bastards. Probably same for Zepbound?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Happy Friday! Zepbound has finally been added to the FEP BCBS program. :D

Good new/ bad news/etc:

Etc: should be obvious, but you will need a prior authorization


Bad News— ouch. About $470/ month standard and $570 basic (costs more than with the coupon)

Better news— the Zepbound co-pay assistance card takes $150 off that. So $320 standard and $420 basic

The jumping for joy news: it should be available via mail order for standard only (basic has no mail order). With the savings card, a three month supply should be $25 ($125 or $80– not clear which tier it is— minus up to $150 to get the copay to $25.

Enjoy!

Not according to the website?

They added it to their drug pricing tool yesterday. Prior to yesterday, it was listed as “not covered”. They still need to added it to the weight management prior authorization policy and elsewhere in the next couple days. But the PA policy should be the same as Wegovy, which costs more and is less effective.

https://www.fepblue.org/pilot/rx-cost-tool/search?defaultUY=true

Is this program/company specific or BCBS wide?

DP - I just checked my private BCBS and Zepbound is still not covered.

Yeah, well … OP is talking about FEP. So.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Yes friends, EVERY BCBS PLAN IS DIFFERENT BASED ON WHAT YOUR EMPLOYER NEGOTIATES WITH THE COMPANY. OP is talking about FEP only. DUH.

Go eat a cookie

THEIR SENTIMENT WAS VALID.

DP

[Anonymous]

Anonymous wrote:Just saw that they've moved Wegovy to Tier 3 (60% copay) instead of Tier 2 ($75 copay) for 2025, the bastards. Probably same for Zepbound?

Crap.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Happy Friday! Zepbound has finally been added to the FEP BCBS program. :D

Good new/ bad news/etc:

Etc: should be obvious, but you will need a prior authorization


Bad News— ouch. About $470/ month standard and $570 basic (costs more than with the coupon)

Better news— the Zepbound co-pay assistance card takes $150 off that. So $320 standard and $420 basic

The jumping for joy news: it should be available via mail order for standard only (basic has no mail order). With the savings card, a three month supply should be $25 ($125 or $80– not clear which tier it is— minus up to $150 to get the copay to $25.

Enjoy!

Not according to the website?

They added it to their drug pricing tool yesterday. Prior to yesterday, it was listed as “not covered”. They still need to added it to the weight management prior authorization policy and elsewhere in the next couple days. But the PA policy should be the same as Wegovy, which costs more and is less effective.

https://www.fepblue.org/pilot/rx-cost-tool/search?defaultUY=true

Is this program/company specific or BCBS wide?

DP - I just checked my private BCBS and Zepbound is still not covered.

Yeah, well … OP is talking about FEP. So.

Right but the previously quoted PP was asking if it was “BCBS wide”. So.