Anonymous wrote:
As of March 30 - no more overrides for Wegovy or Zepound.

My issue with this is that at least for Standard care members, FEHB is offering a service and associated price that they can’t provide so therefore I should be entitled to the mail in coverage price in lieu of in store prices. I’m paying for a benefit I’m not receiving by paying more for Standard to begin with.

I’m not surprised they stopped allowing the tier 3 drug mail order price override.

I can tell you all that I managed to get a tier exception, so I’m paying under $200 (I can’t remember how much exactly— maybe 160ish) which I’m pretty happy about. My doctor sent in the tier exception request and it was granted. I can’t take the other weight loss meds on the formulary because either 1) they are, or contain, a stimulant, which I can’t take because of a medical condition, or 2) one of the non-stimulants interacts with a drug I’m already taking, or 3)the other non-stimulant is one I tried it in the past and I had bad side effects.

You need to look up all of the contraindications for everything on the formulary and see if they apply to you. I almost didn’t bother but then I did bother with it and figured out that the one I thought they’d make me take interacts with my current meds. Its worth looking at. It takes some time, there are a lot of drugs on the formulary and you need to look them up and comb through the contraindications. But you might be able to argue for a tier exception.

As of March 30 - no more overrides for Wegovy or Zepound.

Anonymous wrote:

Anonymous wrote:Hopefully this pressures congress to do something about price gouging. There is no excuse for a drug to cost $1k a month in the US and less than $100 a month in every other country in the world

Zero chance egg nor that a Republican controlled Congress will go anything. They support Big Pharma and Kennedy was crystal clear that he does not support the use of weight loss drugs. So bye bye compounding or cheaper drugs.

Just received another 6 mo of compounded tirzepatide. I will let them figure it out in court and check back a year from now.

Anonymous wrote:Had the mail order override and received this too. Same week as the RIF notice. And when stocks are tanking, savings accounts rates are falling.

What a fun week.

Yes it was a blow on top of my agency being decimated. I’m going to call Caremark today and ask about appealing. If they can’t ship this, they should honor the mail in rate for in-store pick up. Im sure this is a move by fauxOPM to further punish Feds.

Had the mail order override and received this too. Same week as the RIF notice. And when stocks are tanking, savings accounts rates are falling.

What a fun week.

I just received a letter that BCBS FEHB is discontinuing the cost override as 3/31 so now my Wegovy is going back up to $650. Have any other Standard care users received this notice?

Anonymous wrote:

Anonymous wrote:Hopefully this pressures congress to do something about price gouging. There is no excuse for a drug to cost $1k a month in the US and less than $100 a month in every other country in the world

Zero chance egg nor that a Republican controlled Congress will go anything. They support Big Pharma and Kennedy was crystal clear that he does not support the use of weight loss drugs. So bye bye compounding or cheaper drugs.

Compounded meds aren’t going anywhere despite all the pharma lobbying. What congressman wants to vote to end compounded meds that his constituents depend on?

The pharma companies are running scared; PBMs are now buying Wegovy at fire sale prices. That’s why insurance companies are suddenly approving “mail order exemptions” for Wegovy.

Lilly will likely follow suit.

Anonymous wrote:Hopefully this pressures congress to do something about price gouging. There is no excuse for a drug to cost $1k a month in the US and less than $100 a month in every other country in the world

Zero chance egg nor that a Republican controlled Congress will go anything. They support Big Pharma and Kennedy was crystal clear that he does not support the use of weight loss drugs. So bye bye compounding or cheaper drugs.

Anonymous wrote:

Anonymous wrote:Bcbs basic, I just got my tier override.

Did you argue you tried other drugs first, or did you do it by complaining about the mail order unavailability?

I applied for an override with BCBS basic and it was denied. I get Wegovy through a local pharmacy, not CVS, so I'm not sure that I can make the false advertising claim about mail order?

Claimed that I’d tried other meds previously.

Not PP but I am original poster about getting mail delivery price at local pharmacy (now actually get from local for $0 as they also applied manufacture coupon to mail in price). I don’t use CVS. I have BCBS Standard. I recommend calling the number for BCBS Basic, complain about false advertising, and have the BCBS Basic customer service rep call CVS Caremark mail in pharmacy with you on phone. This should prompt CVS Caremark to submit an exception for you to get the mail in rate at your local pharmacy. You should also get coupon from drug website and have your local pharmacy apply that too.

Anonymous wrote:Bcbs basic, I just got my tier override.

Did you argue you tried other drugs first, or did you do it by complaining about the mail order unavailability?

I applied for an override with BCBS basic and it was denied. I get Wegovy through a local pharmacy, not CVS, so I'm not sure that I can make the false advertising claim about mail order?

Bcbs basic, I just got my tier override.

This is accurate. I requested an override and picked up Wegovy just a short while ago $24.99

Congratulations, so glad you went for mail in override and it worked for you too!