Reply to Federal BCBS tier exception for wegovy?

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[quote=Anonymous][quote=Anonymous][quote=Anonymous]Tier exemption for Wegovy is approved for bc bs FEP bringing the cost down to $24.99. There is no tier exemption for Zepbound.

Call CVS Caremark phone # on your id card and they will walk you through it [/quote]

A tier exception will not bring Wegovy down to 24.99 for everyone; that low price is in conjunction with the manufacturer's coupon. The coupon only applies for 13 fills (at least that has been the case to date, for most people); after that Wegovy at a Tier 2 price (which is the tier exception down from Tier 3) is about $400 per month (30% patient contribution on the $1350 retail price). This gets more complicated with behind-the-scenes discounts from the manufacturer; I got a tier exception down to tier 2 on Wegovy, and pay $160 per month; why not $400 when that would be the 30% coinsurance required by fep bcbs? Because there are discounts happening behind the scenes. This is all very opaque, and all designed to keep people buying the drug. Even pharmacists don't understand some of the pricing schemes that happen with this drug.

So you can't just say that a tier exception on fep bcbs standard for Wegovy will bring the price down to $24.99. Because that won't be the case for everyone. I have a tier exception and pay $160 per month, and again -- that won't be the case for everyone.

There is no tier exception for Zepbound because Zepbound isn't covered at all; it's not on a tier to begin with so there isn't going to be a "tier exception."  [/quote]

Thank you! [/quote]

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