Anonymous
Post 07/14/2025 12:04     Subject: Prescribed Zepbound, but BCBS Fed does not cover it
"Hmmm I am on BCBS Fed and it is covered for me. My only qualification is obesity (but not anymore) and I just got it approved for another year. I would call and push back. I still pay $300 out of pocket after coupon though."

This is my situation -- I do think the doctor did some manuvering with the PA or possibly it just took them forever to approve the PA.
Anonymous
Post 07/13/2025 20:43     Subject: Prescribed Zepbound, but BCBS Fed does not cover it
Anonymous wrote:
Anonymous wrote:
Anonymous wrote:I have the same insurance, and my doctor submitted info for prior approval and got it for a year. I would call BCBS and see what you can do.


OP. Thanks. The doctor’s office submitted info for prior approval and BCBS Fed standard rejected it. Did you have to call BCBS to get it approved?


I did not need to but DH did and found out Wegovy was covered instead for him and is taking that.


Does you husband have a BMI that is obese or is he overweight? Does he have another health condition like high cholesterol or diabetes or sleep apnea?
Anonymous
Post 07/09/2025 14:09     Subject: Prescribed Zepbound, but BCBS Fed does not cover it

Have the same insurance. Doctor was able to get it approved
However, it still is going to cost you around $349 a month.

Not sure there is a go around to get that cost lowered.
Anonymous
Post 07/09/2025 09:46     Subject: Prescribed Zepbound, but BCBS Fed does not cover it
Hmmm I am on BCBS Fed and it is covered for me. My only qualification is obesity (but not anymore) and I just got it approved for another year. I would call and push back. I still pay $300 out of pocket after coupon though.
Anonymous
Post 07/09/2025 09:42     Subject: Prescribed Zepbound, but BCBS Fed does not cover it
Anonymous wrote:
Anonymous wrote:I have the same insurance, and my doctor submitted info for prior approval and got it for a year. I would call BCBS and see what you can do.


OP. Thanks. The doctor’s office submitted info for prior approval and BCBS Fed standard rejected it. Did you have to call BCBS to get it approved?


I did not need to but DH did and found out Wegovy was covered instead for him and is taking that.
Anonymous
Post 07/09/2025 09:31     Subject: Prescribed Zepbound, but BCBS Fed does not cover it
Anonymous wrote:I have the same insurance, and my doctor submitted info for prior approval and got it for a year. I would call BCBS and see what you can do.


OP. Thanks. The doctor’s office submitted info for prior approval and BCBS Fed standard rejected it. Did you have to call BCBS to get it approved?
Anonymous
Post 07/09/2025 08:31     Subject: Prescribed Zepbound, but BCBS Fed does not cover it
I have the same insurance, and my doctor submitted info for prior approval and got it for a year. I would call BCBS and see what you can do.
Anonymous
Post 07/09/2025 07:14     Subject: Prescribed Zepbound, but BCBS Fed does not cover it
Anonymous wrote:
Anonymous wrote:Get Wegovy and it is $125 for a three-month supply via Caremark mailorder


Were you actually able to do the mail order?


Yup. They restarted mail order a few weeks ago for the 1.7 and 2.4 doses. But they did not announce it. I learned about it here and it’s saving me $600 a month.
Anonymous
Post 07/09/2025 07:12     Subject: Prescribed Zepbound, but BCBS Fed does not cover it
Anonymous wrote:Get Wegovy and it is $125 for a three-month supply via Caremark mailorder


Were you actually able to do the mail order?
Anonymous
Post 07/09/2025 07:09     Subject: Prescribed Zepbound, but BCBS Fed does not cover it
Get Wegovy and it is $125 for a three-month supply via Caremark mailorder
Anonymous
Post 07/08/2025 19:57     Subject: Prescribed Zepbound, but BCBS Fed does not cover it
Thank you. How do I join Lily direct?
Anonymous
Post 07/08/2025 19:56     Subject: Prescribed Zepbound, but BCBS Fed does not cover it
Typo - $349
Anonymous
Post 07/08/2025 19:56     Subject: Prescribed Zepbound, but BCBS Fed does not cover it
Most of us do Lily Direct. It’s $348 for the 2.5 dose, which everyone starts with. You can stay in that dose for a few months. It’s very easy.
Anonymous
Post 07/08/2025 19:55     Subject: Prescribed Zepbound, but BCBS Fed does not cover it
LillyDirect
Anonymous
Post 07/08/2025 19:51     Subject: Prescribed Zepbound, but BCBS Fed does not cover it
My PCP prescribed Zepbound for weight loss. I am obese and have hypertension. I have BCBS Fed standard which does not cover Zepbound. Out of pocket with coupon is 750 dollars per month. Is there any way to get this medication in a more affordable way? Thank you.