Wegovy moving Tiers on BCBS FEP

[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 $2,000 cap only applies to individuals on the FEP Medicare Prescription Drug Program (aka Medicare Part D).

[Anonymous]

Anonymous wrote: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.

We need more of this kind of crowdsourced info about specific plans. Insurance carriers aggressively hide information to lure unsuspecting into terrible deals. Educated consumers are a nightmare for them.

-Not on GLP1s

[Anonymous]

I don't understand how the plan brochure and formulary get away with not stating what the plan allowance is? What is the point of telling me I'll pay x% of an unknown number?

[Anonymous]

Anonymous wrote:I don't understand how the plan brochure and formulary get away with not stating what the plan allowance is? What is the point of telling me I'll pay x% of an unknown number?

It's part of their scam. Without the insurance lobby, the house of cards would tumble.

[Anonymous]

Anonymous wrote:

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

I saw that after I looked-yikes.

Looking at other plans now and also considering getting the med from another source. Maybe one of those places that charge by the month.

[Anonymous]

Has anyone figured out the new cost?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

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

I saw that after I looked-yikes.

Looking at other plans now and also considering getting the med from another source. Maybe one of those places that charge by the month.

This is not a real solution. The compounding pharmacies are only allowed to sell compounded Semaglutide right now because there is a shortage of Wegovy. Once the shortage is over, which it should be very very soon, they won’t be able to violate the patent by selling it. so this is not a long-term solution.

Also, my doctor won’t allow it because of safety concerns. But nobody seems to care about safety concerns. So.

[Anonymous]

Anonymous wrote:I don't understand how the plan brochure and formulary get away with not stating what the plan allowance is? What is the point of telling me I'll pay x% of an unknown number?

These numbers are negotiated. Either they have not arrived at an agreed upon price with Norvo yet, or they have but it isn’t public yet.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

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

I saw that after I looked-yikes.

Looking at other plans now and also considering getting the med from another source. Maybe one of those places that charge by the month.

This is not a real solution. The compounding pharmacies are only allowed to sell compounded Semaglutide right now because there is a shortage of Wegovy. Once the shortage is over, which it should be very very soon, they won’t be able to violate the patent by selling it. so this is not a long-term solution.

Also, my doctor won’t allow it because of safety concerns. But nobody seems to care about safety concerns. So.

I'm the PP. I'm able to get Wegovy with no problem (just got it yesterday), it's the cost that I'm concerned about. A month of compounded, cash, is way cheaper than a month of Wegovy cash.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I don't understand how the plan brochure and formulary get away with not stating what the plan allowance is? What is the point of telling me I'll pay x% of an unknown number?

These numbers are negotiated. Either they have not arrived at an agreed upon price with Norvo yet, or they have but it isn’t public yet.

Basic will be $771 for a 28 day supply in 2025 according to Fep Blue’s drug tool. I assume BCBS already negotiated and that’s why wegovy is on the formulary and not zepbound.

[Anonymous]

Anonymous wrote:

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

Lol.

No.

Omg, no. You get nothing for a good price on these plans.

[Anonymous]

Anonymous wrote:I don't understand how the plan brochure and formulary get away with not stating what the plan allowance is? What is the point of telling me I'll pay x% of an unknown number?

That’s how insurance works. It is absolutely insane.

[Anonymous]

It’s like none of you understand what insurance is. It isn’t subsidized healthcare.

[Anonymous]

Just FYI BCBS has gotten so expensive that IMO it is not worth the cost anymore. Switched to Aetna, have been very happy and never looked back. Foreign Service Benefit Plan to be specific

[Anonymous]

Anonymous wrote:Just FYI BCBS has gotten so expensive that IMO it is not worth the cost anymore. Switched to Aetna, have been very happy and never looked back. Foreign Service Benefit Plan to be specific

Agreed!!! I wish our organization was available to do FSBP https://www.afspa.org/eligibility/ I only thought it was applicable to DoS, but I was wrong.

I've been seeing on Reddit that people are looking at GEHA (which is essentially United Health Care), MHBP (which is essentially AETNA) for cost/value/etc. MHBP has a $52 or so dues per year. I listened to an MHBP info session, and they said, of course, every insurance can change Rx tiers during the year. YMMV.

I guess it's time to do some research on all these plans and check w/ my providers if they're dropping anything. I've been on BCBS for 5+ years!