Hi OP- I get the ask. I have FEPBCBS Basic so now have prescription and coverage for Zepbound. I picked it up and my copay was $550 which is what it was costing with the mfg coupon.

From following online it looks like Standard is better for coverage.

I was unable to find Wegovy which would be covered so out of desperation did the Zepbound. My doc thinks that another drug in the marketplace will ease the shortages all around and in a few months Zepbound will have similar coverage as Wegovy.

Anonymous wrote:

Anonymous wrote:I got PA in 24 hours with FEPBCBS. But when I got PA 2/1, they told me it was approved as of 1/1, and expires in July. I doubt I will be able to get Wegovy before 3/1. So I will have to lose enough in about 4 months to justify them renewing it.

Op here—Sorry this is confusing; I’m sure you were just typing fast in your phone!

Are you solely talking about Wegovy or are you saying you also got a PA for Zepbound? Im unclear what you mean when you say you’ll doubt you will be able “to get Wegovy” and yet at the same time “have to lose enough” to justify renewing it (Wegovy??)

Sorry, yes I am on my phone.
I got PA for Wegovy, but have not been able to fill the prescription yet due to the shortage. My pharmacy thinks it will be available at the end of this month. I think I have to lose 5% of my body weight to justify renewing PA. But if I don’t maybe I can get Zepbound. But I think the cost will be much higher than Wegovy.

Anonymous wrote:Someone posted a few weeks ago that Zepbound has been covered under FEPBCBS effective 2/1.

I saw that post and so I looked it up. The new formulary I read says Zepbound will only be covered IF you’ve done Wegovy and if did not work for you. See below:

https://info.caremark.com/content/dam/enterprise/caremark/microsites/dig/pdfs/pa-fep/fep-criteria/FEP_Criteria_Zepbound.pdf


I’m curious (1) has anyone successfully gotten Zepbound covered by this because Wegovy is unavailable? And (2) should I go ahead and get a prior authorization done for Wegovy anyway?

Someone posted a few weeks ago that Zepbound has been covered under FEPBCBS effective 2/1.

Anonymous wrote:I got PA in 24 hours with FEPBCBS. But when I got PA 2/1, they told me it was approved as of 1/1, and expires in July. I doubt I will be able to get Wegovy before 3/1. So I will have to lose enough in about 4 months to justify them renewing it.

Op here—Sorry this is confusing; I’m sure you were just typing fast in your phone!

Are you solely talking about Wegovy or are you saying you also got a PA for Zepbound? Im unclear what you mean when you say you’ll doubt you will be able “to get Wegovy” and yet at the same time “have to lose enough” to justify renewing it (Wegovy??)

I got PA in 24 hours with FEPBCBS. But when I got PA 2/1, they told me it was approved as of 1/1, and expires in July. I doubt I will be able to get Wegovy before 3/1. So I will have to lose enough in about 4 months to justify them renewing it.

In light of the shortage, I am curious about whether to have my PCP seek authorization now? Wegovy doesn’t seem to be available. But, if I could fine it, it’d be nice to have the prior authorization ready.

I am also curious about whether anyone has had success getting fepblue to pay for Zepbound in light of the unavailability of Wegovy. (I’ve read the formulary and understand that Fepblue says it will only pay for Zepbound after you have tried Wegovy).