I'm going with MHBP. But I'm single and don't see many doctors or specialists so it's a no brainer.

However, they can change their formulary quarterly. MHBP covers Wegovy for a reasonable price in Q1, but with everyone making a mass exodus from BCBS, that may change come April. But at least I'll be able to have it a few more months and then go from there.

Anonymous wrote:

Anonymous wrote:I just looked it up via my current Fed Kaiser plan and Wegovy is covered as a Tier 2 med so depending on your plan you pay a copay, for the standard plan it was $40/30 day supply. Dr. also offered me other options like generic versions of Qysmia which doesn't get as much news coverage right now but is another option - that was a tier 1 so $10 copay/month.

Just checked and it is the same in the 2025 formulary for Kaiser fed plans. So still well covered. And we love Kaiser, can't really say enough good things about it. Worth considering.

To the PP who recommends Kaiser: Have you had any concerns regarding coverage in other respects? My entire family is on my BCBS Fed policy and they often see specialists at Children’s, Georgetown, GW, Inova for various issues and special needs. We have been on BCBS forever so I am nervous about restarting a new plan dealing with providers in/out network. Ice never had issues with BCBS FEP coverage at major hospitals etc. Maybe I should just sacrifice my own weight loss in order to maintain the status quo for everyone else but that doesn’t seem right either.

Kaiser it is

Anonymous wrote:I just looked it up via my current Fed Kaiser plan and Wegovy is covered as a Tier 2 med so depending on your plan you pay a copay, for the standard plan it was $40/30 day supply. Dr. also offered me other options like generic versions of Qysmia which doesn't get as much news coverage right now but is another option - that was a tier 1 so $10 copay/month.

Just checked and it is the same in the 2025 formulary for Kaiser fed plans. So still well covered. And we love Kaiser, can't really say enough good things about it. Worth considering.

Anonymous wrote:I'm on Wegovy now (have been for around 6 months). I have BCBS Basic and the cost is going from $25/month to $700...so I'm switching to a compound, likely through Weight Watchers, where it will be $200/month (ish), including the WW plan, and their clinic. I looked at other plans (GEHA looks like it might cover Wegovy), but for our family, the predictability of a fee for service plan outweighs other considerations. The formularies for all plan are available online for you to investigate. Or you can call them.

NP and this is what I am going to have to do as well. Same exact scenarios. First was on ozempic bc of obesity, pre diabetes, and high blood pressure. Than federal BCBS stopped coverage for ozempic. Switched to Wegovy for the same reasons and was paying $25/month for a year. And now fed BCBS is reducing coverage on that for 2025 and confirmed it will be $771.26/month for the same dose and supply and drug. I’m just so deflated and depressed. This drug has kept me from becoming diabetic, and helped with my blood pressure and chronic pain issues related to obesity/joints.

I am now planning to look at other programs like WW for the compounded versions bc I cannot afford a jump from $25 to almost $800 a month.

I also called Wegovy and they said bc of a “law” they are unable to provide manufacturer coupons or discounts to anyone who has a federal insurance. So they couldn’t help either. Screwed on both ends.

My advice - don’t bother.

I just looked it up via my current Fed Kaiser plan and Wegovy is covered as a Tier 2 med so depending on your plan you pay a copay, for the standard plan it was $40/30 day supply. Dr. also offered me other options like generic versions of Qysmia which doesn't get as much news coverage right now but is another option - that was a tier 1 so $10 copay/month.

Anonymous wrote:Fed here who is on Wegovy.

I don't think there is an easy answer to this. If no one on your insurance has any major health issues and keeping your doctor(s) isn't a priority, you could just start researching the 2025 drug formularies of all offered plans. I haven't bothered because we are sticking with FEP BCBS standard because it makes sense for us for multiple reasons even though my out-of-pocket for Wegovy will now be a lot more.

It's an all-facts-and-circumstances thing. So you are going to need to figure this out for you. No one can answer this easily.

Switch to a compound!

Anonymous wrote:Do the medicines help with high cholesterol?

It depends on the person but as with all things, not unless you also change your diet. These meds don't work in their own like magic. You have to change your diet, exercise etc.

I'm on Wegovy now (have been for around 6 months). I have BCBS Basic and the cost is going from $25/month to $700...so I'm switching to a compound, likely through Weight Watchers, where it will be $200/month (ish), including the WW plan, and their clinic. I looked at other plans (GEHA looks like it might cover Wegovy), but for our family, the predictability of a fee for service plan outweighs other considerations. The formularies for all plan are available online for you to investigate. Or you can call them.

Do the medicines help with high cholesterol?

Anonymous wrote:Look up the benefeds table and compare them. Do you always have others do your work for you? Wow.

The benefeds table says nothing about how different insurance handles a specific medication.

Fed here who is on Wegovy.

I don't think there is an easy answer to this. If no one on your insurance has any major health issues and keeping your doctor(s) isn't a priority, you could just start researching the 2025 drug formularies of all offered plans. I haven't bothered because we are sticking with FEP BCBS standard because it makes sense for us for multiple reasons even though my out-of-pocket for Wegovy will now be a lot more.

It's an all-facts-and-circumstances thing. So you are going to need to figure this out for you. No one can answer this easily.

There is discussion of this on this thread -- https://www.dcurbanmom.com/jforum/posts/list/1233279.page

Zepbound has the fewest side effects so I would look for coverage for that.

Look up the benefeds table and compare them. Do you always have others do your work for you? Wow.

I am obese with high cholesterol. Not diabetic. Which insurance should i get for best coverage? Thanks in advance.