Any Feds on Wegovy or Saxenda?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:BCBS basic covers wegovy with a prior authorization

Do you know if BCBS basic covers Mounjaro as well with a prior authorization?

I have BCBS. You first have to try metformin and ozempic, then they will pay for Mounjaro.

Basic? I just got approved for Mounjaro (was on Metformin for 10 yrs) and the co-pay was 1658.00!

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:BCBS basic covers wegovy with a prior authorization

Do you know if BCBS basic covers Mounjaro as well with a prior authorization?

I have BCBS. You first have to try metformin and ozempic, then they will pay for Mounjaro.

Basic? I just got approved for Mounjaro (was on Metformin for 10 yrs) and the co-pay was 1658.00!

If that’s the copay, it likely needs to be re-run through the insurance again after the prior auth was approved. BCBS basic has no deductible so the cost should be your highest copay. $1600 sounds like the cash price for the drug without insurance

[Anonymous]

I am a fed with BCBS Basic. I have an appt with my doctor this week to talk about a Wegovy script. Can anyone tell me about the prior authorization procedure for BCBS Basic? Want to make sure I have all my ducks in a row.

[Anonymous]

You can try using sample letters here.
https://www.wegovy.com/coverage-and-savings/wegovy-coverage-options.html

As a patient, there is little you can do on prior authorization. Just make sure your doc has your whole med history, all the treatments you’ve tried, so they can include in the letter.

[Anonymous]

Anonymous wrote:I'm so confused. I'm a new fed, what plan should I choose to get ozempic or wegovy covered? Or at least best chances? I'm obese but not diabetic. Ozempic has been working wonders for me but I can't keep paying out of pocket forever.

BC/BS Standard option. Stay away from basic option.

[Anonymous]

Anonymous wrote:

Anonymous wrote:BCBS basic covers wegovy with a prior authorization

What is the copay? Thanks.

I’m paying about $250 for 28 days

[Anonymous]

Anonymous wrote:

Anonymous wrote:I'm so confused. I'm a new fed, what plan should I choose to get ozempic or wegovy covered? Or at least best chances? I'm obese but not diabetic. Ozempic has been working wonders for me but I can't keep paying out of pocket forever.

BC/BS Standard option. Stay away from basic option.

Why? When I was choosing insurance and did the prescription calculator, it was actually much more affordable with BCBS Basic.

[Anonymous]

Anonymous wrote:I am a fed with BCBS Basic. I have an appt with my doctor this week to talk about a Wegovy script. Can anyone tell me about the prior authorization procedure for BCBS Basic? Want to make sure I have all my ducks in a row.

Hello, I am a fed with BCBS basic whose prior auth was approved. My dr just had to call and verify that I met the prescribing indication of either BMI over 30 or BMI 27-30 with a weight-related comorbidity (htn, high cholesterol, diabetes, etc).

Good luck! I think mine was approved for 6 months. She did the PAs for the first 2 doses, so I have my first 2 months of therapy already.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I'm so confused. I'm a new fed, what plan should I choose to get ozempic or wegovy covered? Or at least best chances? I'm obese but not diabetic. Ozempic has been working wonders for me but I can't keep paying out of pocket forever.

BC/BS Standard option. Stay away from basic option.

Why? When I was choosing insurance and did the prescription calculator, it was actually much more affordable with BCBS Basic.

Wegovy is cheaper with basic than standard. Also, with basic you can pick up in-store at the pharmacy, whereas with standard you can only get it with mail-order.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I'm so confused. I'm a new fed, what plan should I choose to get ozempic or wegovy covered? Or at least best chances? I'm obese but not diabetic. Ozempic has been working wonders for me but I can't keep paying out of pocket forever.

BC/BS Standard option. Stay away from basic option.

Why? When I was choosing insurance and did the prescription calculator, it was actually much more affordable with BCBS Basic.

Wegovy is cheaper with basic than standard. Also, with basic you can pick up in-store at the pharmacy, whereas with standard you can only get it with mail-order.

Okay phew. I really agonized over choosing a plan this year because I've had such great success with Ozempic and needed to make sure I could get it or Wegovy relatively affordably. I went with Basic.

[Anonymous]

BCBS Basic and Ozempic is $24.99. Feels too good to be true, even though I researched ahead of time I just figured there would be some hiccup or catch. But nope, no prior authorization, no diagnosis code needed. I’ve been on state insurance which doesn’t cover it and paying out of pocket via Canadian pharmacies until now so even with the premiums this is much more affordable.

[Anonymous]

Anonymous wrote:BCBS Basic and Ozempic is $24.99. Feels too good to be true, even though I researched ahead of time I just figured there would be some hiccup or catch. But nope, no prior authorization, no diagnosis code needed. I’ve been on state insurance which doesn’t cover it and paying out of pocket via Canadian pharmacies until now so even with the premiums this is much more affordable.

Another fed with BCBS basic on Wegovy. I had a PA approved and am also paying 24.99. My insurance copay is $60 but the pharmacy applied a coupon without me even asking!

[Anonymous]

Anonymous wrote:

Anonymous wrote:BCBS Basic and Ozempic is $24.99. Feels too good to be true, even though I researched ahead of time I just figured there would be some hiccup or catch. But nope, no prior authorization, no diagnosis code needed. I’ve been on state insurance which doesn’t cover it and paying out of pocket via Canadian pharmacies until now so even with the premiums this is much more affordable.

Another fed with BCBS basic on Wegovy. I had a PA approved and am also paying 24.99. My insurance copay is $60 but the pharmacy applied a coupon without me even asking!

Good to know you can use a coupon to make it the same price, I went with Ozempic because it was cheaper and I also really like the ability to customize dosing. My worry is that they will stop covering Ozempic for non-diabetics as many plans are and I will have lost enough weight that I will no longer qualify for Wegovy. Maybe I should get a pre-auth for it now while I’m still technically obese…

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:BCBS Basic and Ozempic is $24.99. Feels too good to be true, even though I researched ahead of time I just figured there would be some hiccup or catch. But nope, no prior authorization, no diagnosis code needed. I’ve been on state insurance which doesn’t cover it and paying out of pocket via Canadian pharmacies until now so even with the premiums this is much more affordable.

Another fed with BCBS basic on Wegovy. I had a PA approved and am also paying 24.99. My insurance copay is $60 but the pharmacy applied a coupon without me even asking!

Good to know you can use a coupon to make it the same price, I went with Ozempic because it was cheaper and I also really like the ability to customize dosing. My worry is that they will stop covering Ozempic for non-diabetics as many plans are and I will have lost enough weight that I will no longer qualify for Wegovy. Maybe I should get a pre-auth for it now while I’m still technically obese…

If you pull the insurance formulary, you’ll see that 24.99 is not your copay- your pharmacy also applies a coupon.

[Anonymous]

Anonymous wrote:

Anonymous wrote:BCBS basic covers wegovy with a prior authorization

What is the copay? Thanks.

$25.00. Could not believe it. Pharmacist was also shocked.