Fep Blue Standard GLP- coverage for obesity?

[Anonymous]

Anonymous wrote:

Anonymous wrote:Well after 3 years with a prior authorization (not always filled over that time) FEP BCBS denied my prior authorization. Not sure why yet given I have lots of other health issues. Thought I’d share because it may be a trend.

My bet is that with Trump negotiating for cash prices to drop there is a range of cost where insurers have determined that if its less than X dollars out of pocket then people will buy it using cash versus using insurance and then the insurer will still get all the benefits of those of us who have decreased BMI, decreased cholesterol, decreased inflammation, etc. without having to cost share it. They are negotiating Medicare/Medicaid costs for it so those who cant afford OOP will be covered thus leaving only LMC in the lurch.

Add in that Lilly has multiple new GLP-1s ++ in trials.

+1. And insurance companies cover for these denials with gaslighting about 22 BMI influencers.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Will they cover for someone pre-diabetic? DH is about to go on one and we have fed blue standard.

No. They don't care at all about "pre-diabetic." That wasn't even one of the conditions ever considered for coverage (like sleep apnea or high blood pressure or cardiovascular disease).

Sorry you're wrong.

I have BCBS and am pre diabetic. I am on wegovy, $25/month

[Anonymous]

Anonymous wrote:

Anonymous wrote:I can't believe I didn't know if this massive change before Open Season ended. It's 10 times more expensive now!!!! And their justification basically is...too many people needed it and we were losing profits so we just had to stop covering it.

No medical justification.

Just...sorry, we can't make money while covering this. GFU.

I hate for-profit health insurance. Our country is so sick.

Well, their justification definitely makes sense. It's an insurance company -- not subsidized healthcare. I wish we had a single payer system, but we don't. And for-profit companies are going to do their thing.

For profit companies are regulated all the time. Plus, insurance companies sell us their products via the government, including the exchange and Medicare Advantage. They have abused that privilege, which is why United Healthcare is facing criminal prosecution for defrauding the taxpayers and their customers.

Most of us taxpayers have experienced abuses from insurance companies and are angry about it. That's why UHC's PR campaigns keep falling flat. The regulation hammer will inevitably fall because that's what voters want.

[Anonymous]

I am the PP who has been off and on Mounjaro or Zepbound for 3 years with an insurance prior approval the last 2 but denied now. The new price would have been $1100 a month starting Jan 1 but with the Lilly Savings card, it is down to $500 a month self pay. When I had insurance it was about $335 a month.