Reply to Wegovy moving Tiers on BCBS FEP

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[quote=Anonymous][quote=Anonymous][quote=Anonymous]I got a tier exception! My doctor filed a request for a tier exception yesterday, and it was granted today. So I'll be continuing to pay Tier 2 prices this year even though it has moved to Tier 3. [/quote]

What is the secret sauce?[/quote]

You have to qualify for it. Specifically -- you need actual medical reasons you can't take the lower tiered drugs on the formulary.

The weight loss medications on tier 1 and tier 2 of the FEP BCBS formulary are Orlistat or stimulants (or have a stimulant component). I cannot take stimulants and I take a medication that interacts with Orlistat. I hadn't even really planned on trying for a tier exception, and was just going to pay the $700ish OOP, but for some reason I decided to look at the formulary and I knew most of the meds there were stimulants and I couldn't have them, but I saw Orlistat and thought "Well, they'll make me take that." But then I decided it couldn't hurt for me to bother to look up contraindications and sure enough as I looked through the drugs it can interact with I saw "anti-convulsants" -- and I'm on one.

So I drafted up a short note for my doctor's office listing all of the lower tier meds and why I can't take each of them, and attached a copy of the tier exception form, and they filled it out and signed it and sent it, and I had the notice from BCBS within 24 hours that it had been approved. So I'm back to getting Wegovy for $24.99 a month. I feel very, very fortunate. [/quote]

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