Any Feds on Wegovy or Saxenda?

[Anonymous]

Anonymous wrote:

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

It was approved and I even called and talked to them to confirm the co-pay was 1580.00. Ozempic was only 60.00 for a 90 day supply so I’ll try that. So strange.

[Anonymous]

Thought youd all be curious. I was quoted over $3400 for wegovy with Kaiser FEHB for a 3 month supply. I fit most of the criteria. First time I’ve felt frustrated by KP FEHB before.
It seems that some KP FEHB locations outside of the Mid-Atlantic region do cover it. Why are we excluded ?? Other regional KP plans may cover it. Just not the FEHB. I cried a little.

[Anonymous]

Anonymous wrote:Thought youd all be curious. I was quoted over $3400 for wegovy with Kaiser FEHB for a 3 month supply. I fit most of the criteria. First time I’ve felt frustrated by KP FEHB before.
It seems that some KP FEHB locations outside of the Mid-Atlantic region do cover it. Why are we excluded ?? Other regional KP plans may cover it. Just not the FEHB. I cried a little.

Did your KP doc prescribe? I thought if KP prescribed it should be your copay but the difficulty is getting them to prescribe.

[Anonymous]

I have fed bcbs and was pretty easily approved for Saxenda through the Sequence website. Have been on it for six weeks and lost 15 pounds with no side effects (other than not having an appetite, which I guess is the point).

[Anonymous]

We have BCBS and I was covered for Mounjaro (same class of drugs as Ozempic, etc.), but my blood sugar was in the diabetic range for more than a year, tried unsuccessfully to keep off significant amounts of weight and was about 60-70 pounds overweight. Keep in mind if you have a history of thyroid cancer in your family, your doctor won't prescribe it. I'd imagine there are other conditions that may prohibit you from taking these drugs, but the black box warning in regarding thyroid cancer.

[Anonymous]

Sorry, PP here. When I saw I was "covered" for Mounjaro, I still have to pay about $350/month out of pocket, so it's still quite expensive.

[Anonymous]

Federal BCBS Standard. I switched from GEHA High last open season because GEHA did not have weight loss drugs on their formulary. Payed about $100/ month for Wegovy for first 4 doses, titrating up, with a Wegovy coupon. Now that my dose is stable, can get 3 months supply for $90 mail order.

[Anonymous]

Well it's our everywhere for months so why does it matter

[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.

You can pick up standard in store. But, it’s cheaper with mail order.

The copay is smaller with basic. But, we use out of network mental health services. So, big picture, standard is much better for us, even if this particular drug costs more.

[Anonymous]

Anonymous wrote:Well it's our everywhere for months so why does it matter

1.7 and 2.4 (maintenance doses) are available.

[Anonymous]

Anonymous wrote:I asked my family practice physician about Wegovy last fall. I am near 50 and my BMI is over 30. I have struggled with my weight my whole life. I am a vegetarian with PCOS. My doctor said while I would be a good candidate for the medication she thought I should try weightlifting and becoming a full vegan for three months. If that didn't work she said she would recommend weight loss surgery. My blood work was excellent. I told her I am not interested in surgery and wanted to try Wegovy and she said "there are doctors out there who will prescribe it," and sent me on my way. Does anyone have a recommendation for a Virginia-based doctor who might be able to help? Should I just find a local endocrinologist and make an appointment?

INOVA has a medical weight loss PA who can prescribe it: https://www.inova.org/our-services/inova-nonsurgical-weight-loss-program

[Anonymous]

So, my BMI is 30 so it sounds like I would qualify with BCBS Basic. But, once I lose 20 lbs I would have a lower BMI so do they stop covering it?

[Anonymous]

Anonymous wrote:So, my BMI is 30 so it sounds like I would qualify with BCBS Basic. But, once I lose 20 lbs I would have a lower BMI so do they stop covering it?

They should not stop covering it because you lost weight. But if you were to stop taking the drug, you would gain all the weight back.
It’s a long-term, if not lifetime, commitment

[Anonymous]

BCBS fep standard covered Rybelsus for me -- I just had a $25 copay. Didn't take it for long b/c of awful side effects, but that's another story.

[Anonymous]

I have GEHA standard and been on Wegovy since January. The regular co-pay without the savings card is $200/month through CVS Caremark. Down 50 lbs and labs are all back to normal. Cancer survivor, high bp, high chol, sleep apnea, fatty liver, pre-diabetic. I went through Sequence because my PCP had no interest in writing it (even though she told me she had tried it). Funny how the doctors will take the meds but won't write them for their patients. Obesity bias to the max still in healthcare. These meds have changed my life.