Reply to Fep Blue Standard GLP- coverage for obesity?

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[quote=Anonymous][quote=Anonymous]I have Federal BC/BS and I'm trying to get Wegovy or Zepbound for obesity (I'm pre diabetic, have high blood pressure, and BMI is over 40.)

My doctor said she thinks Fep Blue just changed their policy to no longer cover GLP-1 for obesity, only diabetes, except at the non-preferred level, which would be 50%, so I'd be paying like $600 out of pocket each month where last year I believe it was $50.

[b]Does that sound right to you? [/b] I'm trying to read their alert about changing tiers for GLP-1 online and it's very vague; I think my understanding is that I could get a "tier exception" for Zepbound but then it would still only be Tier 3, which is 50% covered.

Is that right?  Or is anyone else on GLP-1 and getting it covered by Fep Blue?[/quote]

Yes, that sounds exactly right. I have FEP BCBS standard, and I am on Wegovy.

I did get a tier exception for Wegovy and picked it up today. With the tier exception and the Novo Nordisk coupon, I paid $162.

To get the tier exception, my doctor filed a request for it stating why I can't take the lower tier alternatives on the formulary. I can't take stimulants and Orlistat interacts with a med I'm already on. [/quote]

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