FEHB and Wegovy
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Anonymous
The 600-something is before coupon. But the max discount on the coupon is $225. So you are still looking at around $400-ish. |
Anonymous
| Does anyone know how much Mounjaro will be under BCBS Basic for 2025? |
Anonymous
I was wondering this too. I was playing around on the bcbs website and it seemed like Mounjaro would still be $25. Is that correct? I'm currently on Wegovy but my weight loss stalled out after loosing 45 pounds. My doctor prescribed Mounjaro but I was initially denied by bcbs although we're appealing. I still have a fair amount of weight to loose but I think my BMI may have just dropped below obese into overweight. Not sure if that was why I was denied but they recently reauthorized my Wegovy prescription so who knows. Very frustrating! |
Anonymous
The rest of us don't want to pay the premium increases for all the people on these expensive drugs! Insurance is too damn expensive already! |
Anonymous
You have to be diabetic for mounjaro I think |
Anonymous
I only see Wegovy and Saxenda listed. |
Anonymous
I don't want to pay for your mental health visits or your IVF. Work somewhere you get a high deductible health plan and see how you feel about the cost of insurance. |
Anonymous
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Wegovy costs $24 with our insurance for a month supply.
BCBC (feds btw) |
Anonymous
You may want to read the first post in this thread. It costs that much NOW, but in 2025.... |
Anonymous
Right, but the point if this thread is that it is going to cost hundreds of dollars more in 2025 because it is being moved to Tier 3. |
Anonymous
Had. I switched to BCBS because it seemed like everything— every service, every med— needed a PA, and my PAs across multiple providers and multiple family members were getting denied, appealed, denied again, doctor got on a peer to peer call and GEHA MD was a no show. MH reimbursement is better. But, I was also getting self submitted OON my claims kicked back regularly. GEHA is better reimbursement. But you need to get the reimbursement. I reached a point we were changing meds to things less effective and paying out of pocket for pain management procedures, because of ongoing Pa denials Under BCBS standard, with Zepbound plus mental health plus pain management procedures, I have hit my out of pocket max of $6000 by June. Once I hit mine, it’s not far for my kids and DH to hit there’s. Months 1-3 are doable because if my FSa plus the extra money they give you for entering your BP or going to preventative appointments. Months 4-6 suck, but I’ve gotten used to budgeting $1000 a month for medical three months. Stating in June or July, Zepbound is free— everything in network is free—because I’ve hit my max. By August Sept, OON mental health is free up to the reimbursement amount (which is about $20 less than my therapist charges). I had major surgery, a hospital stay, extensive PT and OT starting in August. I’ve paid $0 to hospital, MD, PT, OT, meds associated with the surgery. Because I met my max. And yes, the time of the surgery was intentional. I have never had a PA issue. And even though Zepbound is only available under an exception, I was able to easily get it by my MD saying ai had plateaued on Wegovy and Saxenda conflicted with a med I was taking. PA just renewed for Zepbound for a full year. GEHA is probably better financially— when they pay. My MDs (multiple) hate using them though, and say it is definitely not just me. My pain management can get procedure approval in one day for BCBS. They must allow 2 weeks for GEHA. And I kept having procedures I was taking off work for cancelled the day of because GEHA was still mulling. And I’m an administrative lawyer. So, I can fill out paperwork properly. It’s not a me issue. |
Anonymous
BCBS PA requires x% weight loss (5% maybe) in 4-6 months to get a renewal. After the renewal, you only need to maintain weight on the GLP-1 to get a new PA. Not lose weight. Maintain on the meds. At least for now. As I said above— Admin lawyer— I read paperwork. |
Anonymous
It’s Zepbound for weight loss. And not covered by BCBS unless you can get an exception. I got on easily because my MD certified I had plateaued on Wegovy and that Saxenda was counter indicated based on my current meds. Otherwise, you have to try both these drugs before they will approve Zepbound. |