How are people getting weightloss medication approved by insurance?

[Anonymous]

I have BCBS FEP standard, and it is covered. I paid $24.99 per month this past year, and with the 2025 coverage changes to 50% coinsurance my portion will be $750 out of pocket per month going forward.

It is a lot, and we will feel it, but I have lost 45lbs so far, and don't want to die from something caused by obesity. The normal "diet and exercise!!" exhortations will be ignored by me as my weight gain is medication related and Wegovy is what works for me. My doctor will not prescribe to compounding pharmacies for safety reasons, so I take her advice and go with the brand name.

[Anonymous]

Anonymous wrote:I pay out of pocket for compound. Been on it for almost 2 years. Just in maintenance now, which is about $80/month (low dose shots every 2 weeks).

Where do you get yours?

[Anonymous]

Anonymous wrote:I have BCBS FEP standard, and it is covered. I paid $24.99 per month this past year, and with the 2025 coverage changes to 50% coinsurance my portion will be $750 out of pocket per month going forward.

It is a lot, and we will feel it, but I have lost 45lbs so far, and don't want to die from something caused by obesity. The normal "diet and exercise!!" exhortations will be ignored by me as my weight gain is medication related and Wegovy is what works for me. My doctor will not prescribe to compounding pharmacies for safety reasons, so I take her advice and go with the brand name.

Can you sign up for the manufacturer coupon? It could save $225 per month.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I have BCBS FEP standard, and it is covered. I paid $24.99 per month this past year, and with the 2025 coverage changes to 50% coinsurance my portion will be $750 out of pocket per month going forward.

It is a lot, and we will feel it, but I have lost 45lbs so far, and don't want to die from something caused by obesity. The normal "diet and exercise!!" exhortations will be ignored by me as my weight gain is medication related and Wegovy is what works for me. My doctor will not prescribe to compounding pharmacies for safety reasons, so I take her advice and go with the brand name.

Can you sign up for the manufacturer coupon? It could save $225 per month.

Yes, I already have the coupon. I forgot about that. I should still have some fills on it (I think the limit is 13 months worth on the coupon?). Which means my out-of-pocket will come down to $500ish.

[Anonymous]

Anonymous wrote:I was on Wegovy for $25/month and just found out that Blue Cross Blue Shield won't cover it, so now it's $775/month. There's no way I can stay on the meds now. That's a problem I haven't figured out the answer to yet.

Oh no! We just switched from Aetna to BCBS.

[Anonymous]

Anonymous wrote:Some insurance plans pay for it, some do not. My previous employer included weight loss medicine as part of our plan with CIGNA while my current employer does not. Both plans were CIGNA OAP, but because employers choose what is covered within that plan, my previous employer chose a different prescription plan than my current employer, which is (a) owned by a private equity firm and (b) run by a bunch of old white men married to their hot skinny second wives.

I pay $24 a month with CIGNA. My doctor said I have good insurance. I hope she’s right and I don’t get cut off because Wegovy is working for me.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I have BCBS FEP standard, and it is covered. I paid $24.99 per month this past year, and with the 2025 coverage changes to 50% coinsurance my portion will be $750 out of pocket per month going forward.

It is a lot, and we will feel it, but I have lost 45lbs so far, and don't want to die from something caused by obesity. The normal "diet and exercise!!" exhortations will be ignored by me as my weight gain is medication related and Wegovy is what works for me. My doctor will not prescribe to compounding pharmacies for safety reasons, so I take her advice and go with the brand name.

Can you sign up for the manufacturer coupon? It could save $225 per month.

Yes, I already have the coupon. I forgot about that. I should still have some fills on it (I think the limit is 13 months worth on the coupon?). Which means my out-of-pocket will come down to $500ish.

Before you do that: does your RX coverage change when you hit your deductible? If so, what is the deductible?

What is your max OOP?

My biologic has a high copay, but my max OOP is so low that I hit it in the first quarter, and then there is no out of pocket for any medical care or prescription. If I use the manufacturer coupons or GoodRX, the pharmacy can’t run it through my insurance, which means I don’t hit my max OOP. It’s actually cheaper for me to pay the copay and hit the max OOP.

Run the numbers for your plan.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I have BCBS FEP standard, and it is covered. I paid $24.99 per month this past year, and with the 2025 coverage changes to 50% coinsurance my portion will be $750 out of pocket per month going forward.

It is a lot, and we will feel it, but I have lost 45lbs so far, and don't want to die from something caused by obesity. The normal "diet and exercise!!" exhortations will be ignored by me as my weight gain is medication related and Wegovy is what works for me. My doctor will not prescribe to compounding pharmacies for safety reasons, so I take her advice and go with the brand name.

Can you sign up for the manufacturer coupon? It could save $225 per month.

Yes, I already have the coupon. I forgot about that. I should still have some fills on it (I think the limit is 13 months worth on the coupon?). Which means my out-of-pocket will come down to $500ish.

Before you do that: does your RX coverage change when you hit your deductible? If so, what is the deductible?

What is your max OOP?

My biologic has a high copay, but my max OOP is so low that I hit it in the first quarter, and then there is no out of pocket for any medical care or prescription. If I use the manufacturer coupons or GoodRX, the pharmacy can’t run it through my insurance, which means I don’t hit my max OOP. It’s actually cheaper for me to pay the copay and hit the max OOP.

Run the numbers for your plan.

Thanks. Really good point, everyone should consider all of this and run their numbers.

Unfortunately for me, deductible won't affect what I'll pay for Wegovy, and our annual OOP max is 12k. The coupon I have from Norvo works in conjunction with my insurance. Using the coupon or not using it -- I won't hit my OOP. Unless we have other unforeseen health care costs this year -- in which case I'll re-evaluate.

[Anonymous]

Anonymous wrote:People are paying $300ish out of pocket for compounded meds

I was 5’2” and 155 with high bp. Insurance approved the meds for me, I pay $30 per month.