Anonymous wrote:
Trying to sort this all out this morning.
Was told $639.49.

That's how much I paid this month.

Trying to sort this all out this morning.
Was told $639.49.

I'm on BCBS Basic, and had a conversation with them last week about weight loss meds. Was shocked to learn I have to pay 60% co-pay for weight loss meds. The good news is that I was recently diagnosed with type 2 diabetes, and can get the same meds for $35 per month.

Anonymous wrote:

Anonymous wrote:I can't believe I didn't know if this massive change before Open Season ended. It's 10 times more expensive now!!!! And their justification basically is...too many people needed it and we were losing profits so we just had to stop covering it.

No medical justification.

Just...sorry, we can't make money while covering this. GFU.

I hate for-profit health insurance. Our country is so sick.

So many people were lying about BMIs, co-morbid conditions, etc. Lots of weird telemedicine going on, etc.
Blue Cross does not want to pay $1000/month for the Instagram influencers to go from a BMI of 22 to a BMI of 18.

There was so much abuse of this (I work in the insurance world). I don't blame Blue Cross.
Yes, it stinks for those who are actually obese.

Influencers with a BMI of 22 do not and did not qualify for Wegovy. And I'm not sure how many patients are lying -- as you know, you can't do your own pa, your doctor has to sign it. I'm sure there was some abuse of this (as you point out -- the scammy telemed companies), but that isn't why the insurance companies have reduced or eliminated coverage for it. They have reduced or eliminated coverage for it because there are enough who actually do qualify for it for it to be too expensive for them.

Anonymous wrote:For those using a coupon to bring prices down (Zepbound is literally $681 with Fed BC/BS Standard!), how long can you qualify for the coupons? I did that once with a drug company but only got a discount for like 3 months.

I don't want to start a med that I can't afford to keep taking.

Supposedly the Novo Nordisk coupon for Wegovy is good for 13 mos. I don't know about Zep.

Anonymous wrote:I can't believe I didn't know if this massive change before Open Season ended. It's 10 times more expensive now!!!! And their justification basically is...too many people needed it and we were losing profits so we just had to stop covering it.

No medical justification.

Just...sorry, we can't make money while covering this. GFU.

I hate for-profit health insurance. Our country is so sick.

Well, their justification definitely makes sense. It's an insurance company -- not subsidized healthcare. I wish we had a single payer system, but we don't. And for-profit companies are going to do their thing.

Anonymous wrote:I can't believe I didn't know if this massive change before Open Season ended. It's 10 times more expensive now!!!! And their justification basically is...too many people needed it and we were losing profits so we just had to stop covering it.

No medical justification.

Just...sorry, we can't make money while covering this. GFU.

I hate for-profit health insurance. Our country is so sick.

So many people were lying about BMIs, co-morbid conditions, etc. Lots of weird telemedicine going on, etc.
Blue Cross does not want to pay $1000/month for the Instagram influencers to go from a BMI of 22 to a BMI of 18.

There was so much abuse of this (I work in the insurance world). I don't blame Blue Cross.
Yes, it stinks for those who are actually obese.

Anonymous wrote:For those using a coupon to bring prices down (Zepbound is literally $681 with Fed BC/BS Standard!), how long can you qualify for the coupons? I did that once with a drug company but only got a discount for like 3 months.

I don't want to start a med that I can't afford to keep taking.

It’s $549 if you get from Eli lily direct (vials) I pay $650 for the pen and it says good through the end of the year (no insurance coverage) I just started it, but I’m hoping I will have to pay out-of-pocket no more than two years

With the coupon I paid $420, last year it was $25 (Wegovy).

Anonymous wrote:I can't believe I didn't know if this massive change before Open Season ended. It's 10 times more expensive now!!!! And their justification basically is...too many people needed it and we were losing profits so we just had to stop covering it.

No medical justification.

Just...sorry, we can't make money while covering this. GFU.

I hate for-profit health insurance. Our country is so sick.

It definitely sucks, but FEP BCBS sent multiple letters notifying us of the change. I started getting compounded sema from Weight Watchers this month instead of the $700 it would cost now with bcbs basic

For those using a coupon to bring prices down (Zepbound is literally $681 with Fed BC/BS Standard!), how long can you qualify for the coupons? I did that once with a drug company but only got a discount for like 3 months.

I don't want to start a med that I can't afford to keep taking.

Anonymous wrote:I can't believe I didn't know if this massive change before Open Season ended. It's 10 times more expensive now!!!! And their justification basically is...too many people needed it and we were losing profits so we just had to stop covering it.

No medical justification.

Just...sorry, we can't make money while covering this. GFU.

I hate for-profit health insurance. Our country is so sick.

My obesity doc said that other companies are also working on these drugs (plus a new oral semaglutide) and that prices will start to come down with competition. I hope he is right, I have no coverage and it is $650/month

I can't believe I didn't know if this massive change before Open Season ended. It's 10 times more expensive now!!!! And their justification basically is...too many people needed it and we were losing profits so we just had to stop covering it.

No medical justification.

Just...sorry, we can't make money while covering this. GFU.

I hate for-profit health insurance. Our country is so sick.

Anonymous wrote:I have Federal BC/BS and I'm trying to get Wegovy or Zepbound for obesity (I'm pre diabetic, have high blood pressure, and BMI is over 40.)

My doctor said she thinks Fep Blue just changed their policy to no longer cover GLP-1 for obesity, only diabetes, except at the non-preferred level, which would be 50%, so I'd be paying like $600 out of pocket each month where last year I believe it was $50.

Does that sound right to you? I'm trying to read their alert about changing tiers for GLP-1 online and it's very vague; I think my understanding is that I could get a "tier exception" for Zepbound but then it would still only be Tier 3, which is 50% covered.

Is that right? Or is anyone else on GLP-1 and getting it covered by Fep Blue?

Yes, that sounds exactly right. I have FEP BCBS standard, and I am on Wegovy.

I did get a tier exception for Wegovy and picked it up today. With the tier exception and the Novo Nordisk coupon, I paid $162.

To get the tier exception, my doctor filed a request for it stating why I can't take the lower tier alternatives on the formulary. I can't take stimulants and Orlistat interacts with a med I'm already on.

I have Federal BC/BS and I'm trying to get Wegovy or Zepbound for obesity (I'm pre diabetic, have high blood pressure, and BMI is over 40.)

My doctor said she thinks Fep Blue just changed their policy to no longer cover GLP-1 for obesity, only diabetes, except at the non-preferred level, which would be 50%, so I'd be paying like $600 out of pocket each month where last year I believe it was $50.

Does that sound right to you? I'm trying to read their alert about changing tiers for GLP-1 online and it's very vague; I think my understanding is that I could get a "tier exception" for Zepbound but then it would still only be Tier 3, which is 50% covered.

Is that right? Or is anyone else on GLP-1 and getting it covered by Fep Blue?