Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Why does everyone who is a fed announce it? What does being a fed have to do with getting weight loss drugs?

Because generally your health insurance is provided through your employer.

So are nearly all working individuals. No one announces they aren’t fed.

DP - OP said they are a fed, so others who are also feds with the same insurance can chime in. It just makes this more apples to apples advice.

Anonymous wrote:

Anonymous wrote:Why does everyone who is a fed announce it? What does being a fed have to do with getting weight loss drugs?

Because generally your health insurance is provided through your employer.

So are nearly all working individuals. No one announces they aren’t fed.

Anonymous wrote:Why does everyone who is a fed announce it? What does being a fed have to do with getting weight loss drugs?

Because generally your health insurance is provided through your employer.

Why does everyone who is a fed announce it? What does being a fed have to do with getting weight loss drugs?

My insurance covers some products for obesity. You have to be a certain BMI to qualify, and a dr has to fill out a special form.

Do you know if your insurance covers meds for obesity?

Anonymous wrote:

Anonymous wrote:I'm a Fed with BCBS and it's covered. I recommend you make an appointment at a weight loss clinic as they are familiar with the insurance and drug availability issues, as well as the dietary support you need.

NP - question for you. Under the fed. coverage, is there no exclusion for weight loss medications?

No. OPM requires federal employee plans to cover at least on GLP-1 med. I have FEP BCBS standard. It and basic cover Wegovy and Saxenda for BMI 27 + a weight related health issue (prediabetes, hypertension, etc) OR BMI 30, with no need for something else. Zepbound requires failing Wegovy and Saxenda. I plateaued on Wegovy at the end of 2023 (65 pounds down in 8 month). My MD was able to get Zepbound approved by finding something in my health history that made Saxenda counter-indicated.

You may need to start with Saxenda or Wegovy instead of Zepbound. But of you are BMI 30 or BMI 27 with another health problem you should have no trouble getting a PA for a weight loss med. mine took less than 48 hours. I had to lose 5% of my body weight in 5 months, which I did with 30 pounds to spare. And then PA renewal took less than 2 hours.

Starting last year federal plans were required to cover weight loss meds. They require preauthorization. I've seen someone on Reddit link a document that has the BCBS eligibility criteria, you may want to look on there. I think it's obesity at a certain BMI, or a certain BMI + a comorbidity (which could be diabetes, cholesterol etc). Agree with the PP who suggested a weight loss doctor, the preauthorization process is not easy and you want someone who can navigate it.

Anonymous wrote:

Anonymous wrote:I'm a Fed with BCBS and it's covered. I recommend you make an appointment at a weight loss clinic as they are familiar with the insurance and drug availability issues, as well as the dietary support you need.

NP - question for you. Under the fed. coverage, is there no exclusion for weight loss medications?

Different poster, but also a fed. Fed BCBS covers some weight loss medications in some situations. It requires prior authorization which has to be renewed every six months.

Anonymous wrote:I'm a Fed with BCBS and it's covered. I recommend you make an appointment at a weight loss clinic as they are familiar with the insurance and drug availability issues, as well as the dietary support you need.

That's great to know - thank you!

Anonymous wrote:I'm a Fed with BCBS and it's covered. I recommend you make an appointment at a weight loss clinic as they are familiar with the insurance and drug availability issues, as well as the dietary support you need.

NP - question for you. Under the fed. coverage, is there no exclusion for weight loss medications?

I'm a Fed with BCBS and it's covered. I recommend you make an appointment at a weight loss clinic as they are familiar with the insurance and drug availability issues, as well as the dietary support you need.

What I have experienced is that they want you to try and have failed on two or three previous weight loss drugs, or have your doctor exclude them for medical reasons (for me, two were excluded because I have primary insomnia). I failed on Saxenda, so now I get Zepbound.

Find the list from Carefirst of try and fail drugs, then try and fail, then they will likely cover

What is your BMI?

It varies by insurance plan. A general rule seems to be BMI over 30 and co-morbidities will get covered. Hypertension counts as a co-morbidity. It is not limited to pre-diabetes.

Hi, all.

I've read that some insurance plans decline to cover Ozempic, Wegovy, et al. if you're not diabetic or prediabetic.

I'm neither - just fat. Healthy diet and regular cardio exercise over the past year have failed to shift the weight.

If it matters, I'm a fed with Care First Blue Choice. Calls to them have received vague answers.