Reply to Zepound finally hits FEP BCBS

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[quote=Anonymous][quote=Anonymous]it's not added to mail service at this time 2/21/2024. No date on when it will be but it is at the 474.13 cost right now if you ahve PA.[/quote]

Mine is a bit over $350 under BCBS standard. Zepbound’s coupon will take $150 off the insurance price.

The big issue is that you have to try Wegovy and Saxenda before Zepbound.  I had stalled on Wegovy, and had moved to Zepbound as soon as it was available.  And had zero desire to stop what was working In order to check the Saxenda box. My PA went through the Saxenda prescribing information with me and we found a “prescribe with caution” or “may not be appropriate if…” condition documented in my medical history. So, she put in the PA that Saxenda was counter indicated because….  I was surprised it worked. But, I’m now approved through August.

Looking at pharmacy receipts, BCBS pays more in cost sharing for Wegovy than Zepbound.  So, I’m not sure why they  make it so much harder to get.  My guess is that it’s because no one can get the lower doses of Wegovy to start and BCBS won’t count unavailability as a reason for not trying Wegovy first. Which reinforces the point that insurance companies suck.

I did pay OOP ($550) for two months waiting for BCBS to get it together and approve Zepbound. And was pleasantly surprised to see that they
 Backdated the PA by one month. So, one of the fills is eligible for reimbursement by BCBS. [/quote]

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