Reply to Getting weight-loss medication covered by insurance if you're not diabetic or prediabetic

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[quote=Anonymous][quote=Anonymous][quote=Anonymous]I'm a Fed with BCBS and it's covered. I recommend you make an appointment at a weight loss clinic as they are familiar with the insurance and drug availability issues, as well as the dietary support you need. [/quote]

NP - question for you. Under the fed. coverage, is there no exclusion for weight loss medications?[/quote]

No.  OPM requires federal employee plans to cover at least on GLP-1 med.  I have FEP BCBS standard. It and basic cover Wegovy and Saxenda for BMI 27 + a weight related health issue (prediabetes, hypertension, etc) OR BMI 30, with no need for something else. Zepbound requires failing Wegovy and Saxenda. I plateaued on Wegovy at the end of 2023 (65 pounds down in 8 month). My MD was able to get Zepbound approved by finding something in my health history that made Saxenda counter-indicated.

You may need to start with Saxenda or Wegovy instead of Zepbound. But of you are BMI 30 or BMI 27 with another health problem you should have no trouble getting a PA for a weight loss med. mine took less than 48 hours. I had to lose 5% of my body weight in 5 months, which I did with 30 pounds to spare. And then PA renewal took less than 2 hours. [/quote]

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