Wegovy moving Tiers on BCBS FEP

[Anonymous]

Does Aetna cover the meds?

[Anonymous]

Anonymous wrote:I spoke with BCBS FEP again this morning and the cost for me (20 years in fed on BCBS Basic) is changing from $25 for a month supply to $771.26/month starting January 1.

This is cost-prohibitive for most of us. What are folks doing? My entire Family including unemployed spouse (due to cancer diagnosis) is on my Fed health insurance and I don’t want to lose coverage. I guess I will have to go back to being obese again with heart condition, chronic pain, and pre-diabetic.

I asked the BCBs rep what alternatives are. They they said none. The drug was bumped to Tier 3 across the board. I asked Wegovy what options there are and the rep said none. They are no longer able to provide coupons for savings to federal employees “due to a law which prohibits them from providing coupon savings to any federal or government related insured patients.”

So basically I will have to stop the drug. I can’t believe Feds are being penalized yet again. One reason we work for the Fed for below market salary is because of benefits like health insurance and now those are being taken away.

What are others doing?

Interesting. Novo Nordisk is angry about the move to Tier 3. They provided coupons before this.

At any rate "those" benefits that keep us working for the feds at lower-than-private-industry salaries aren't being taken away. One tiny piece of it has been adjusted. As mentioned in a PP above, most private insurance plans have stopped covering Wegovy altogether. To have 50% coinsurance on a GLP-1 is a much better situation than most working in the private sector are getting at this point. I'm not sure why people don't understand this.

As far as what I am doing goes -- I'm going to adjust my budget and pay for it. Which will not be easy, but it is what we have decided to do. I imagine most will go the compounding route, but my doctor won't prescribe to compounding pharmacies due to safety concerns, and compounds won't be available at all once the shortage is resolved, which will likely happen almost immediately with the changes to coverage and most folks going off of it. Wegovy is still on patent and will be for years, so the compounding companies will likely disappear pretty quickly.

[Anonymous]

Anonymous wrote:those of you looking to switch, kaiser permanente has been covering wegovy for me. i’m on the standard plan, and it’s $40/mo.

unfortunately, bc i can’t tolerate the 2.4 dose of wegovy, i want to try zepbound, but kp won’t let me switch.

Can you say more about your situation and doctor? I was a Kaiser patient for decades but I switched specifically to get Wegovy.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I spoke with BCBS FEP again this morning and the cost for me (20 years in fed on BCBS Basic) is changing from $25 for a month supply to $771.26/month starting January 1.

This is cost-prohibitive for most of us. What are folks doing? My entire Family including unemployed spouse (due to cancer diagnosis) is on my Fed health insurance and I don’t want to lose coverage. I guess I will have to go back to being obese again with heart condition, chronic pain, and pre-diabetic.

I asked the BCBs rep what alternatives are. They they said none. The drug was bumped to Tier 3 across the board. I asked Wegovy what options there are and the rep said none. They are no longer able to provide coupons for savings to federal employees “due to a law which prohibits them from providing coupon savings to any federal or government related insured patients.”

So basically I will have to stop the drug. I can’t believe Feds are being penalized yet again. One reason we work for the Fed for below market salary is because of benefits like health insurance and now those are being taken away.

What are others doing?

Interesting. Novo Nordisk is angry about the move to Tier 3. They provided coupons before this.

At any rate "those" benefits that keep us working for the feds at lower-than-private-industry salaries aren't being taken away. One tiny piece of it has been adjusted. As mentioned in a PP above, most private insurance plans have stopped covering Wegovy altogether. To have 50% coinsurance on a GLP-1 is a much better situation than most working in the private sector are getting at this point. I'm not sure why people don't understand this.

As far as what I am doing goes -- I'm going to adjust my budget and pay for it. Which will not be easy, but it is what we have decided to do. I imagine most will go the compounding route, but my doctor won't prescribe to compounding pharmacies due to safety concerns, and compounds won't be available at all once the shortage is resolved, which will likely happen almost immediately with the changes to coverage and most folks going off of it. Wegovy is still on patent and will be for years, so the compounding companies will likely disappear pretty quickly.

I have been a fed for 20 and have been paid grossly under market all this time. I stayed because of benefits like comprehensive medical insurance for my family, pension, QOL, flex schedule, and job security. Now ALL of this is being threatened to be taken away.

So, Bravo - Good for you that you can pay $771 out pocket. But most Feds who are already underpaid cannot afford a jump from $25 to almost $800/month for a medication. I’ve been taking this drug for over a year and it has helped prevent me from becoming diabetic, has improved HBP, and also reduced chronic pain due to obesity-related issues like plantar fasciitis. In a month I will have to quit it cold turkey or pay.

To go from $25 to nearly $800 month is 32x the cost. Not sure what percent of an increase but it’s awful.

[Anonymous]

Anonymous wrote:

Anonymous wrote:those of you looking to switch, kaiser permanente has been covering wegovy for me. i’m on the standard plan, and it’s $40/mo.

unfortunately, bc i can’t tolerate the 2.4 dose of wegovy, i want to try zepbound, but kp won’t let me switch.

Can you say more about your situation and doctor? I was a Kaiser patient for decades but I switched specifically to get Wegovy.

it is very clearly on their formulary, I'm a different pp but also have been discussing trying it with my Kaiser doc. Here is the 2025 formulary, it is a Tier 2 drug so for a standard plan $40/month.

https://healthy.kaiserpermanente.org/content/dam/kporg/final/documents/formularies/nw/federal-employees-health-benefit-drug-formulary-nw-en-2025.pdf

For the other pp, Zepbound isn't in the formulary so that is why they can't switch you.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I spoke with BCBS FEP again this morning and the cost for me (20 years in fed on BCBS Basic) is changing from $25 for a month supply to $771.26/month starting January 1.

This is cost-prohibitive for most of us. What are folks doing? My entire Family including unemployed spouse (due to cancer diagnosis) is on my Fed health insurance and I don’t want to lose coverage. I guess I will have to go back to being obese again with heart condition, chronic pain, and pre-diabetic.

I asked the BCBs rep what alternatives are. They they said none. The drug was bumped to Tier 3 across the board. I asked Wegovy what options there are and the rep said none. They are no longer able to provide coupons for savings to federal employees “due to a law which prohibits them from providing coupon savings to any federal or government related insured patients.”

So basically I will have to stop the drug. I can’t believe Feds are being penalized yet again. One reason we work for the Fed for below market salary is because of benefits like health insurance and now those are being taken away.

What are others doing?

Interesting. Novo Nordisk is angry about the move to Tier 3. They provided coupons before this.

At any rate "those" benefits that keep us working for the feds at lower-than-private-industry salaries aren't being taken away. One tiny piece of it has been adjusted. As mentioned in a PP above, most private insurance plans have stopped covering Wegovy altogether. To have 50% coinsurance on a GLP-1 is a much better situation than most working in the private sector are getting at this point. I'm not sure why people don't understand this.

As far as what I am doing goes -- I'm going to adjust my budget and pay for it. Which will not be easy, but it is what we have decided to do. I imagine most will go the compounding route, but my doctor won't prescribe to compounding pharmacies due to safety concerns, and compounds won't be available at all once the shortage is resolved, which will likely happen almost immediately with the changes to coverage and most folks going off of it. Wegovy is still on patent and will be for years, so the compounding companies will likely disappear pretty quickly.

I have been a fed for 20 and have been paid grossly under market all this time. I stayed because of benefits like comprehensive medical insurance for my family, pension, QOL, flex schedule, and job security. Now ALL of this is being threatened to be taken away.

So, Bravo - Good for you that you can pay $771 out pocket. But most Feds who are already underpaid cannot afford a jump from $25 to almost $800/month for a medication. I’ve been taking this drug for over a year and it has helped prevent me from becoming diabetic, has improved HBP, and also reduced chronic pain due to obesity-related issues like plantar fasciitis. In a month I will have to quit it cold turkey or pay.

To go from $25 to nearly $800 month is 32x the cost. Not sure what percent of an increase but it’s awful.

Switch to Kaiser pp. You have the option to change your insurance now. Nothing is perfect, but overall our family has been happier with Kaiser than any insurance in the past - by far.

[Anonymous]

Anonymous wrote:I spoke with BCBS FEP again this morning and the cost for me (20 years in fed on BCBS Basic) is changing from $25 for a month supply to $771.26/month starting January 1.

This is cost-prohibitive for most of us. What are folks doing? My entire Family including unemployed spouse (due to cancer diagnosis) is on my Fed health insurance and I don’t want to lose coverage. I guess I will have to go back to being obese again with heart condition, chronic pain, and pre-diabetic.

I asked the BCBs rep what alternatives are. They they said none. The drug was bumped to Tier 3 across the board. I asked Wegovy what options there are and the rep said none. They are no longer able to provide coupons for savings to federal employees “due to a law which prohibits them from providing coupon savings to any federal or government related insured patients.”

So basically I will have to stop the drug. I can’t believe Feds are being penalized yet again. One reason we work for the Fed for below market salary is because of benefits like health insurance and now those are being taken away.

What are others doing?

Are you sure this is true? If so, it's a new law. They aren't allowed to provide coupons to federal insurance like Medicaid, but FEHB plans are commercial insurance. This is confusing for a lot of pharmacy techs and they always think they can't run my coupon until I explain to them.

Not that the coupon helps bring the cost down to anything reasonable once it switches tiers.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:those of you looking to switch, kaiser permanente has been covering wegovy for me. i’m on the standard plan, and it’s $40/mo.

unfortunately, bc i can’t tolerate the 2.4 dose of wegovy, i want to try zepbound, but kp won’t let me switch.

Can you say more about your situation and doctor? I was a Kaiser patient for decades but I switched specifically to get Wegovy.

it is very clearly on their formulary, I'm a different pp but also have been discussing trying it with my Kaiser doc. Here is the 2025 formulary, it is a Tier 2 drug so for a standard plan $40/month.

https://healthy.kaiserpermanente.org/content/dam/kporg/final/documents/formularies/nw/federal-employees-health-benefit-drug-formulary-nw-en-2025.pdf

For the other pp, Zepbound isn't in the formulary so that is why they can't switch you.

Thanks but if I've already lost weight (because of Wegovy) I am concerned Kaiser won't prescribe. My current weight loss clinic supports my staying on it because of my history with it but says they couldn't prescribe something different now because I'm no longer obese. They also prescribed to my DH but he hasn't been able to find it at pharmacies at the intro dose. That's why I wanted to know more from PP.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:those of you looking to switch, kaiser permanente has been covering wegovy for me. i’m on the standard plan, and it’s $40/mo.

unfortunately, bc i can’t tolerate the 2.4 dose of wegovy, i want to try zepbound, but kp won’t let me switch.

Can you say more about your situation and doctor? I was a Kaiser patient for decades but I switched specifically to get Wegovy.

it is very clearly on their formulary, I'm a different pp but also have been discussing trying it with my Kaiser doc. Here is the 2025 formulary, it is a Tier 2 drug so for a standard plan $40/month.

https://healthy.kaiserpermanente.org/content/dam/kporg/final/documents/formularies/nw/federal-employees-health-benefit-drug-formulary-nw-en-2025.pdf

For the other pp, Zepbound isn't in the formulary so that is why they can't switch you.

Thanks but if I've already lost weight (because of Wegovy) I am concerned Kaiser won't prescribe. My current weight loss clinic supports my staying on it because of my history with it but says they couldn't prescribe something different now because I'm no longer obese. They also prescribed to my DH but he hasn't been able to find it at pharmacies at the intro dose. That's why I wanted to know more from PP.

Ah gotcha that is tough. That is the difficult thing with these drugs right now and has been a hesitation for me in starting them.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:those of you looking to switch, kaiser permanente has been covering wegovy for me. i’m on the standard plan, and it’s $40/mo.

unfortunately, bc i can’t tolerate the 2.4 dose of wegovy, i want to try zepbound, but kp won’t let me switch.

Can you say more about your situation and doctor? I was a Kaiser patient for decades but I switched specifically to get Wegovy.

it is very clearly on their formulary, I'm a different pp but also have been discussing trying it with my Kaiser doc. Here is the 2025 formulary, it is a Tier 2 drug so for a standard plan $40/month.

https://healthy.kaiserpermanente.org/content/dam/kporg/final/documents/formularies/nw/federal-employees-health-benefit-drug-formulary-nw-en-2025.pdf

For the other pp, Zepbound isn't in the formulary so that is why they can't switch you.

Thanks but if I've already lost weight (because of Wegovy) I am concerned Kaiser won't prescribe. My current weight loss clinic supports my staying on it because of my history with it but says they couldn't prescribe something different now because I'm no longer obese. They also prescribed to my DH but he hasn't been able to find it at pharmacies at the intro dose. That's why I wanted to know more from PP.

Yeah, this is a big question. When my doctor told me that obesity is a chronic condition and I'd need to be on Wegovy for life I told her "Yeah, I hear you, but tell the insurance companies that. I'll be surprised if they continue to pay for a very expensive anti-obesity med for anyone whose BMI is no longer in the obese range." Then with the added wrinkle you have, of being on it, getting below an obese BMI, and then switching insurance and trying to get coverage there? It's a problem.

I've had no problem getting my Wegovy filled at Costco. At the 0.25, 0.5 and 1 doses. But with BCBS fep moving Wegovy to Tier 3, I'll definitely need to move my scrip to a preferred pharmacy to get that 50% coinsurance -- and Costco is not one.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I spoke with BCBS FEP again this morning and the cost for me (20 years in fed on BCBS Basic) is changing from $25 for a month supply to $771.26/month starting January 1.

This is cost-prohibitive for most of us. What are folks doing? My entire Family including unemployed spouse (due to cancer diagnosis) is on my Fed health insurance and I don’t want to lose coverage. I guess I will have to go back to being obese again with heart condition, chronic pain, and pre-diabetic.

I asked the BCBs rep what alternatives are. They they said none. The drug was bumped to Tier 3 across the board. I asked Wegovy what options there are and the rep said none. They are no longer able to provide coupons for savings to federal employees “due to a law which prohibits them from providing coupon savings to any federal or government related insured patients.”

So basically I will have to stop the drug. I can’t believe Feds are being penalized yet again. One reason we work for the Fed for below market salary is because of benefits like health insurance and now those are being taken away.

What are others doing?

Are you sure this is true? If so, it's a new law. They aren't allowed to provide coupons to federal insurance like Medicaid, but FEHB plans are commercial insurance. This is confusing for a lot of pharmacy techs and they always think they can't run my coupon until I explain to them.

Not that the coupon helps bring the cost down to anything reasonable once it switches tiers.

I called Wegovy customer service this morning and that is what the rep said. I even said this wasn’t Medicare or Medicaid but was BCBS federal and he insistent that “the law” prohibited them from giving coupon discounts to anyone with any federal insurance. It’s possible that this guy didn’t know firsthand the distinctions (he didn’t seem too bright to be honest….) but I was just as surprised.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:those of you looking to switch, kaiser permanente has been covering wegovy for me. i’m on the standard plan, and it’s $40/mo.

unfortunately, bc i can’t tolerate the 2.4 dose of wegovy, i want to try zepbound, but kp won’t let me switch.

Can you say more about your situation and doctor? I was a Kaiser patient for decades but I switched specifically to get Wegovy.

it is very clearly on their formulary, I'm a different pp but also have been discussing trying it with my Kaiser doc. Here is the 2025 formulary, it is a Tier 2 drug so for a standard plan $40/month.

https://healthy.kaiserpermanente.org/content/dam/kporg/final/documents/formularies/nw/federal-employees-health-benefit-drug-formulary-nw-en-2025.pdf

For the other pp, Zepbound isn't in the formulary so that is why they can't switch you.

Thanks but if I've already lost weight (because of Wegovy) I am concerned Kaiser won't prescribe. My current weight loss clinic supports my staying on it because of my history with it but says they couldn't prescribe something different now because I'm no longer obese. They also prescribed to my DH but he hasn't been able to find it at pharmacies at the intro dose. That's why I wanted to know more from PP.

Yeah, this is a big question. When my doctor told me that obesity is a chronic condition and I'd need to be on Wegovy for life I told her "Yeah, I hear you, but tell the insurance companies that. I'll be surprised if they continue to pay for a very expensive anti-obesity med for anyone whose BMI is no longer in the obese range." Then with the added wrinkle you have, of being on it, getting below an obese BMI, and then switching insurance and trying to get coverage there? It's a problem.

I've had no problem getting my Wegovy filled at Costco. At the 0.25, 0.5 and 1 doses. But with BCBS fep moving Wegovy to Tier 3, I'll definitely need to move my scrip to a preferred pharmacy to get that 50% coinsurance -- and Costco is not one.

Which Costco? Ours (Fairfax) hasn't had it.

[Anonymous]

Anonymous wrote:I spoke with BCBS FEP again this morning and the cost for me (20 years in fed on BCBS Basic) is changing from $25 for a month supply to $771.26/month starting January 1.

This is cost-prohibitive for most of us. What are folks doing? My entire Family including unemployed spouse (due to cancer diagnosis) is on my Fed health insurance and I don’t want to lose coverage. I guess I will have to go back to being obese again with heart condition, chronic pain, and pre-diabetic.

I asked the BCBs rep what alternatives are. They they said none. The drug was bumped to Tier 3 across the board. I asked Wegovy what options there are and the rep said none. They are no longer able to provide coupons for savings to federal employees “due to a law which prohibits them from providing coupon savings to any federal or government related insured patients.”

So basically I will have to stop the drug. I can’t believe Feds are being penalized yet again. One reason we work for the Fed for below market salary is because of benefits like health insurance and now those are being taken away.

What are others doing?

This is BS from an uninformed BCBS rep!!! They're just being salty and obnoxious b/c they've hiked up their premiums and reduced drug coverage. There are plenty of other Fed health plans that are covering GLP-1s for 2025. Examples are MHBP Standard/Consumer and GEHA Elevate Plus. There are MANY threads on reddit about this (see this one for example
https://www.reddit.com/r/fednews/comments/1g7lt3f/bcbs_wegovy_prices_are_out_for_2025/). We are moving to MHBP Standard for 2025. After 15 years on BCBS, we're out!

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I spoke with BCBS FEP again this morning and the cost for me (20 years in fed on BCBS Basic) is changing from $25 for a month supply to $771.26/month starting January 1.

This is cost-prohibitive for most of us. What are folks doing? My entire Family including unemployed spouse (due to cancer diagnosis) is on my Fed health insurance and I don’t want to lose coverage. I guess I will have to go back to being obese again with heart condition, chronic pain, and pre-diabetic.

I asked the BCBs rep what alternatives are. They they said none. The drug was bumped to Tier 3 across the board. I asked Wegovy what options there are and the rep said none. They are no longer able to provide coupons for savings to federal employees “due to a law which prohibits them from providing coupon savings to any federal or government related insured patients.”

So basically I will have to stop the drug. I can’t believe Feds are being penalized yet again. One reason we work for the Fed for below market salary is because of benefits like health insurance and now those are being taken away.

What are others doing?

Are you sure this is true? If so, it's a new law. They aren't allowed to provide coupons to federal insurance like Medicaid, but FEHB plans are commercial insurance. This is confusing for a lot of pharmacy techs and they always think they can't run my coupon until I explain to them.

Not that the coupon helps bring the cost down to anything reasonable once it switches tiers.

I called Wegovy customer service this morning and that is what the rep said. I even said this wasn’t Medicare or Medicaid but was BCBS federal and he insistent that “the law” prohibited them from giving coupon discounts to anyone with any federal insurance. It’s possible that this guy didn’t know firsthand the distinctions (he didn’t seem too bright to be honest….) but I was just as surprised.

I have FEP BCBS Basic and have been using a wegovy coupon for all of 2024. I think the rep was a bit confused. When reps hear "federal", their minds immediately go to medicare/medicaid. With the mega jump in wegovy prices for 2025, we're bailing to another insurer.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:those of you looking to switch, kaiser permanente has been covering wegovy for me. i’m on the standard plan, and it’s $40/mo.

unfortunately, bc i can’t tolerate the 2.4 dose of wegovy, i want to try zepbound, but kp won’t let me switch.

Can you say more about your situation and doctor? I was a Kaiser patient for decades but I switched specifically to get Wegovy.

it is very clearly on their formulary, I'm a different pp but also have been discussing trying it with my Kaiser doc. Here is the 2025 formulary, it is a Tier 2 drug so for a standard plan $40/month.

https://healthy.kaiserpermanente.org/content/dam/kporg/final/documents/formularies/nw/federal-employees-health-benefit-drug-formulary-nw-en-2025.pdf

For the other pp, Zepbound isn't in the formulary so that is why they can't switch you.

Thanks but if I've already lost weight (because of Wegovy) I am concerned Kaiser won't prescribe. My current weight loss clinic supports my staying on it because of my history with it but says they couldn't prescribe something different now because I'm no longer obese. They also prescribed to my DH but he hasn't been able to find it at pharmacies at the intro dose. That's why I wanted to know more from PP.

Yeah, this is a big question. When my doctor told me that obesity is a chronic condition and I'd need to be on Wegovy for life I told her "Yeah, I hear you, but tell the insurance companies that. I'll be surprised if they continue to pay for a very expensive anti-obesity med for anyone whose BMI is no longer in the obese range." Then with the added wrinkle you have, of being on it, getting below an obese BMI, and then switching insurance and trying to get coverage there? It's a problem.

I've had no problem getting my Wegovy filled at Costco. At the 0.25, 0.5 and 1 doses. But with BCBS fep moving Wegovy to Tier 3, I'll definitely need to move my scrip to a preferred pharmacy to get that 50% coinsurance -- and Costco is not one.

Which Costco? Ours (Fairfax) hasn't had it.

Really? Hmmm. That is where I've been getting it. Every month since April. FFX Costco on Ox. Lately I've gotten the auto-response that "Wegovy is out of stock" every time my refill or script gets put in, but I do that a week before I need it and every time it's been filled within a few days of that auto-response. Well, with one exception -- there was one time that they called the Sterling store for me because they were out of it and Sterling had it and I went and got it there. But that was same-day, I hadn't even waited a few days.