I have had no problems on GEHA HDHP though it’s still kind of pricey. About $93/month with 25% co-insurance and after $150 manufacturer coupon. Wish it was cheaper but still seems a lot better than BCBS w/ tier change.

This is after deductible, of course. So I’ll Jane to shell out full price in January but will hit deductible quickly.

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

I doubt OP is asking anyone to do research but there could be someone on here with fed insurance who has the meds covered with obesity and n diabetes. Duh.

Anonymous wrote:Do the medicines help with high cholesterol?

Six months of compound lowers my LDLs & triglycerides. HDL increased

Too late now for Open Enrollment, just seeing this thread but the Foreign Service Benefit Plan is covering Wegovy at a preferred tier. It's not just Foreign Service folks, for example DOD people qualify. Also on Fednews Reddit and on some Wegovy Facebook Posts MHBP and some GEHA plans are still covering at favorable rates.

BCBS

Anonymous wrote:ANyone know about the weight watchers situation? Does their compound work just as well? Do you need a doctor to prescribe?

A clinician at WW Clinic would prescribe the compounded medication if you qualify.

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.

Are they going to get rid of the compounded drugs at the beginning of 2025? That’s what my doctor mentioned.

Adding one thing: they do cover qysmia in its generic forms as a first step (one of the cheaper ones to try before a GLP1) and it actually has very good results for many.

Also for the pp, I agree with others that if you already have specialists definitely consider carefully.

One of the Kaiser posters here and coming back to clarify that my dr actually clarified that though Wegovy is Tier 2 you do have to try some of the other cheaper options first - like Qysmia/phentermine topirimate. So that's what i'll be starting with. If the cheaper meds don't work, then it is considered. So just want to come back and share that.

To the pp asking about Kaiser - we have two kids and absolutely love it. But you need to understand how it works and "buy in" to the system, meaning you will have almost all of your care within the Kaiser system. The thing is - there are plenty of drs to choose from within Kaiser. And if you have something rare or something they don't cover they refer you out to other systems and it is covered (I have both family members and friends this has happened to and they got top notch care with serious brain issues). But you won't be dealing with in network out of network, you'll just be in the kaiser network. It is WAY easier (ped recommends a specialist, referral goes in system, they call me the next day to schedule an appointment and they are almost always QUICK, like see specialist next day) but if you already have specialists you prefer and don't want to leave, then no probably not a good idea because you need to use the in network system at Kaiser.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

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.

Would not switch to Kaiser in your shoes.

+1 And Kaiser may have GLP1s on formulary but pressure the docs to gatekeep the prescriptions.

PP above. I’m just guessing about the gatekeeping. Many insurance-backed community hospitals play that game.

Anonymous wrote:

Anonymous wrote:

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.

Would not switch to Kaiser in your shoes.

+1 And Kaiser may have GLP1s on formulary but pressure the docs to gatekeep the prescriptions.

I have GEHA standard and am on Wegovy. I switched from BCBS last year, and have been happy with GEHA. I have out of network coverage, the network is good (all of my doctors who take insurance are in-network). The reimbursement for out of network therapy is better than BCBS.

For Wegovy, the max is $250/mo. I've been getting it for $25/mo with a coupon, but I think there is a limit how long you can use those.

Anonymous wrote:

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.

That’s incorrect re the law. That is for things like Medicare, Tricare etc. FEHB plans are commercial plans even though you’re employed by the government. I have dealt with this before, including the confusion from pharmacies/pharmaceutical companies, and I’ve used discount coupons numerous times. I’m using one right now for Zepbound.

ANyone know about the weight watchers situation? Does their compound work just as well? Do you need a doctor to prescribe?

Anonymous wrote:

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.

Would not switch to Kaiser in your shoes.