Wegovy moving Tiers on BCBS FEP

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Will this switch affect FEP Standard as well?

Yes, moving to Tier 3 on both.

So it moves from the insured paying 30% to the insured paying 50%? I currently pay $24.99/month, so it won’t be that much more. Or am I missing something?

Yes -- you are missing something. As I posted above, the coupon is what is getting your payment down to $24.99 and the coupon is limited to $225 of savings. So if the amount you have to pay per 50% coinsurance is more than $225 a fill, you will pay it. And I can almost guarantee it will be far more than that. I'm estimating 2025 cost to be somewhere between $400 and $600 a month on BCBS Standard FEP with the coupon -- but costs fluctuate and who knows what kind of negotiating has taken place with Norvo regarding 2025 price.

[Anonymous]

Anonymous wrote:Does anyone know of any plan that can be purchased on the DC Exchange that would cover Wegovy?

Lol.

No.

[Anonymous]

Hopefully this pressures congress to do something about price gouging. There is no excuse for a drug to cost $1k a month in the US and less than $100 a month in every other country in the world

[Anonymous]

Anonymous wrote:Hopefully this pressures congress to do something about price gouging. There is no excuse for a drug to cost $1k a month in the US and less than $100 a month in every other country in the world

Do not underestimate the extent to which lawmakers are in bed Pharma. There is no excuse for a drug to cost $1k in the US and less everywhere else -- but there certainly is a reason.

[Anonymous]

I was doing a tad bit of research this AM. It sorta seems like GEHA and United Health care has some coverage for Wegovy and Zepbound. I need to do some investigating further.

I saw this spreadsheet on Reddit. I don't know if it's 100% accurate. Plus it seems to be missing some plans. https://docs.google.com/spreadsheets/u/1/d/1cwgtYouOl_aAXRe_Nq9gH0CX8cuyW3FfsXgAjtDYoCg/htmlview?pli=1#

Someone said that on 10/19 there will be some more pricing releasing done and BCBS reviews meds quarterly. I think they just did a review but I'm not sure.

Again, not sure if that's accurate, but I'm REALLY bummed. I've been on BCBS Basic for years and now I will prob have to switch.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Will this switch affect FEP Standard as well?

Yes, moving to Tier 3 on both.

So it moves from the insured paying 30% to the insured paying 50%? I currently pay $24.99/month, so it won’t be that much more. Or am I missing something?

You are probably still on the coupon, which only lasts for 13 fills. After that, it will cost $500-600/month even with insurance.

New poster/ I’ve had more than 13 refills, never been on a coupon, always paid 24.99 a month with fep basic

[Anonymous]

I wouldn't worry too much. This is all likely a negotiating stance between BCBS and the Novo. Ultimately, BCBS will not do something that causes huge numbers of its members to move off an incredibly effective weight loss drug, as it will save BCBS a lot of money in the long term.

[Anonymous]

Anonymous wrote:I wouldn't worry too much. This is all likely a negotiating stance between BCBS and the Novo. Ultimately, BCBS will not do something that causes huge numbers of its members to move off an incredibly effective weight loss drug, as it will save BCBS a lot of money in the long term.

I mean ... they have already done it. They moved Wegovy to a Tier 3 med. I have no doubt it was a very studied and considered financial decision that takes into account any willingness of Novo to move on the pricing. The Wegovy has cost BCBS a fortune this year. The fact that we have any coverage at all -- with it being a Tier 3 -- is actually fortunate. Most plans outside of the fed gov just aren't covering it at all any more.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Will this switch affect FEP Standard as well?

Yes, moving to Tier 3 on both.

So it moves from the insured paying 30% to the insured paying 50%? I currently pay $24.99/month, so it won’t be that much more. Or am I missing something?

You are probably still on the coupon, which only lasts for 13 fills. After that, it will cost $500-600/month even with insurance.

New poster/ I’ve had more than 13 refills, never been on a coupon, always paid 24.99 a month with fep basic

You are on the manufacturer's coupon -- you just don't know it. The pharmacy likely applied it automatically. The fact that you have had it at that price with more than 13 fills is either a mistake or there were different limits allowing more fills when you first went on it.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Will this switch affect FEP Standard as well?

Yes, moving to Tier 3 on both.

So it moves from the insured paying 30% to the insured paying 50%? I currently pay $24.99/month, so it won’t be that much more. Or am I missing something?

You are probably still on the coupon, which only lasts for 13 fills. After that, it will cost $500-600/month even with insurance.

New poster/ I’ve had more than 13 refills, never been on a coupon, always paid 24.99 a month with fep basic

I’ve been on it for 17 months and always paid $25.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Hopefully this pressures congress to do something about price gouging. There is no excuse for a drug to cost $1k a month in the US and less than $100 a month in every other country in the world

Do not underestimate the extent to which lawmakers are in bed Pharma. There is no excuse for a drug to cost $1k in the US and less everywhere else -- but there certainly is a reason.

Is it because other countries subsidize the drug or negotiate the price down through national health insurance?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Will this switch affect FEP Standard as well?

Yes, moving to Tier 3 on both.

So it moves from the insured paying 30% to the insured paying 50%? I currently pay $24.99/month, so it won’t be that much more. Or am I missing something?

Yes -- you are missing something. As I posted above, the coupon is what is getting your payment down to $24.99 and the coupon is limited to $225 of savings. So if the amount you have to pay per 50% coinsurance is more than $225 a fill, you will pay it. And I can almost guarantee it will be far more than that. I'm estimating 2025 cost to be somewhere between $400 and $600 a month on BCBS Standard FEP with the coupon -- but costs fluctuate and who knows what kind of negotiating has taken place with Norvo regarding 2025 price.

Out of pocket pharmaceutical costs appear to be capped at $2000 in 2025. That’s $167 per month. Seems reasonable.

[Anonymous]

Anonymous wrote:This is not good for me. I have BCBS Blue Focus. I may end up changing to something else (I'll be in the new postal service plans).

Wegovy isn’t on the 2025 formulary for blue focus

[Anonymous]

Anonymous wrote:Jeez how many of y'all are on these drugs. Smh that the rest of us have to subsidize your prior bad choices. I resent this.

That was my initial thought, but really you’re better off having them lose the weight and avoiding future medical bills. But the price gouging needs to stop.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Will this switch affect FEP Standard as well?

Yes, moving to Tier 3 on both.

So it moves from the insured paying 30% to the insured paying 50%? I currently pay $24.99/month, so it won’t be that much more. Or am I missing something?

Yes -- you are missing something. As I posted above, the coupon is what is getting your payment down to $24.99 and the coupon is limited to $225 of savings. So if the amount you have to pay per 50% coinsurance is more than $225 a fill, you will pay it. And I can almost guarantee it will be far more than that. I'm estimating 2025 cost to be somewhere between $400 and $600 a month on BCBS Standard FEP with the coupon -- but costs fluctuate and who knows what kind of negotiating has taken place with Norvo regarding 2025 price.

Out of pocket pharmaceutical costs appear to be capped at $2000 in 2025. That’s $167 per month. Seems reasonable.

The $2000 cap is only for Medicare beneficiaries