Reply to How are people getting weightloss medication approved by insurance?

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[quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous]I have BCBS FEP standard, and it is covered. I paid $24.99 per month this past year, and with the 2025 coverage changes to 50% coinsurance my portion will be $750 out of pocket per month going forward.

It is a lot, and we will feel it, but I have lost 45lbs so far, and don't want to die from something caused by obesity. The normal "diet and exercise!!" exhortations will be ignored by me as my weight gain is medication related and Wegovy is what works for me. My doctor will not prescribe to compounding pharmacies for safety reasons, so I take her advice and go with the brand name.[/quote]

Can you sign up for the manufacturer coupon?  It could save $225 per month. [/quote]

Yes, I already have the coupon. I forgot about that. I should still have some fills on it (I think the limit is 13 months worth on the coupon?). Which means my out-of-pocket will come down to $500ish. [/quote]

Before you do that: does your RX coverage change when you hit your deductible? If so, what is the deductible?

What is your max OOP?

My biologic has a high copay, but my max OOP is so low that I hit it in the first quarter, and then there is no out of pocket for any medical care or prescription. If I use the manufacturer coupons or GoodRX, the pharmacy can’t run it through my insurance, which means I don’t hit my max OOP. It’s actually cheaper for me to pay the copay and hit the max OOP.

Run the numbers for your plan.[/quote]

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