I spoke with BCBS FEP again this morning and the cost for me (20 years in fed on BCBS Basic) is changing from $25 for a month supply to $771.26/month starting January 1.

This is cost-prohibitive for most of us. What are folks doing? My entire Family including unemployed spouse (due to cancer diagnosis) is on my Fed health insurance and I don’t want to lose coverage. I guess I will have to go back to being obese again with heart condition, chronic pain, and pre-diabetic.

I asked the BCBs rep what alternatives are. They they said none. The drug was bumped to Tier 3 across the board. I asked Wegovy what options there are and the rep said none. They are no longer able to provide coupons for savings to federal employees “due to a law which prohibits them from providing coupon savings to any federal or government related insured patients.”

So basically I will have to stop the drug. I can’t believe Feds are being penalized yet again. One reason we work for the Fed for below market salary is because of benefits like health insurance and now those are being taken away.

What are others doing?

those of you looking to switch, kaiser permanente has been covering wegovy for me. i’m on the standard plan, and it’s $40/mo.

unfortunately, bc i can’t tolerate the 2.4 dose of wegovy, i want to try zepbound, but kp won’t let me switch.

Anonymous wrote:What is the price difference? I pay $24.99 with coupon now, and I think it would be $60 withiut coupon. How much will it be in 2025?

I called and for FEP BCBD basic, my copay will go from $60 in 2024 to $771 in 2025

Oops: I saw this was answered a few posts ago:

"I'm on the FEP Blue Standard. According to their website, the 90 day mail order only went up to $125 but the Retail went up to to over $600. The problem with that is the Mail Order Pharmacy (CVS Caremark) stopped shipment of this back in May. Why do they bother to list Mail Order pricing? Does anyone know if/when it might be coming back to mail order?"

I'm on the FEP Blue Standard. According to their website, the 90 day mail order only went up to $125 but the Retail went up to to over $600. The problem with that is the Mail Order Pharmacy (CVS Caremark) stopped shipment of this back in May.Why do they bother to list Mail Order pricing? Does anyone know if/when it might be coming back to mail order?

Anonymous wrote:

Anonymous wrote:Has anyone been able to speak to BCBS about this? And does being in Maryland w/CareFirst make a difference? I'm not willing to change my BCBS Standard plan just for this so I may just go the compound route but it still seems strange to me that CVS pick-up would not honor the mail price if Caremark won't mail a drug that no longer has a shortage.

I am on BCBS fep standard, and have not spoken to them, but don't feel the need to -- the annual out-of-pocket max is $2,000. So everything over that should be covered. That's enough for me to not bother with changing plans. At any rate, they are not going to give you the mail order price. Shortage has little or nothing to do with that issue at this point.

that out of pocket max is only if you have MEDICARE! not just regular BCBS insurance

Anonymous wrote:Has anyone been able to speak to BCBS about this? And does being in Maryland w/CareFirst make a difference? I'm not willing to change my BCBS Standard plan just for this so I may just go the compound route but it still seems strange to me that CVS pick-up would not honor the mail price if Caremark won't mail a drug that no longer has a shortage.

I called CVS Caremark number yesterday and was told there is no date to start shipping any weight loss drugs at the $125/90 day supply price with BCBS standard. Even if you have standard you will be forced to pay the per month price at a local pharmacy. They will not price match and they do not have to tell anyone what drugs are not available via mail order (unless you specifically ask). personally i feel like this is bait and switch-- they advertise that the drug is X amount, but then they unilaterally decide that they wont carry or ship it and you are forced to go retail. I wish one of the federal workforce newspapers would look at this pharmacy issue. I have had BCBS my entire career (fed and non fed) and i am seriously considering leaving it.

Anonymous wrote:Has anyone been able to speak to BCBS about this? And does being in Maryland w/CareFirst make a difference? I'm not willing to change my BCBS Standard plan just for this so I may just go the compound route but it still seems strange to me that CVS pick-up would not honor the mail price if Caremark won't mail a drug that no longer has a shortage.

I am on BCBS fep standard, and have not spoken to them, but don't feel the need to -- the annual out-of-pocket max is $2,000. So everything over that should be covered. That's enough for me to not bother with changing plans. At any rate, they are not going to give you the mail order price. Shortage has little or nothing to do with that issue at this point.

Has anyone been able to speak to BCBS about this? And does being in Maryland w/CareFirst make a difference? I'm not willing to change my BCBS Standard plan just for this so I may just go the compound route but it still seems strange to me that CVS pick-up would not honor the mail price if Caremark won't mail a drug that no longer has a shortage.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:What am I missing here? It looks like according to Caremark 2025 prices for BCBS Standard, Wegovy is $125 for mail in and $700+ for in-store. I’ve been reading that Caremark has stopped mailing for Wegovy but according to their website it’s in stock and available through mail order (w/prior approval, etc). Is that a mistake? I’m planning to ask my PCP to prescribe to me and I’d pay $125, but am concerned they’ve eliminated the mailing option.

My weight loss doctor says Caremark is not mailing it. I have the same question/concern and if they aren't going to fill the rx they shouldn't be allowed to advertise that price.

They don't really "advertise that price." Per the formulary Tier 3 drugs are that price via mail order. That is -- if available by mail order. Wegovy (and some other Tier 3 drugs as well) is not available by mail order.

They have a calculator on their website where you type in the name of the drug and it gives you the price for different plans and delivery methods. That's where PP got $125 for mail order Wegovy, specifically. So yes, they are advertising the price. If it isn't available by mail they have the ability to indicate that in the calculator.

Anonymous wrote:What am I missing here? It looks like according to Caremark 2025 prices for BCBS Standard, Wegovy is $125 for mail in and $700+ for in-store. I’ve been reading that Caremark has stopped mailing for Wegovy but according to their website it’s in stock and available through mail order (w/prior approval, etc). Is that a mistake? I’m planning to ask my PCP to prescribe to me and I’d pay $125, but am concerned they’ve eliminated the mailing option.

You will not get Wegovy by mail order through Caremark. They have stopped shipping it. If you want Wegovy and have BCBS Standard, the best you will be able to do is 50% coinsurance at a preferred pharmacy. Which will be between $400 and $600 depending on the availability of manufacturer's coupon discounts.

Anonymous wrote:

Anonymous wrote:What am I missing here? It looks like according to Caremark 2025 prices for BCBS Standard, Wegovy is $125 for mail in and $700+ for in-store. I’ve been reading that Caremark has stopped mailing for Wegovy but according to their website it’s in stock and available through mail order (w/prior approval, etc). Is that a mistake? I’m planning to ask my PCP to prescribe to me and I’d pay $125, but am concerned they’ve eliminated the mailing option.

My weight loss doctor says Caremark is not mailing it. I have the same question/concern and if they aren't going to fill the rx they shouldn't be allowed to advertise that price.

They don't really "advertise that price." Per the formulary Tier 3 drugs are that price via mail order. That is -- if available by mail order. Wegovy (and some other Tier 3 drugs as well) is not available by mail order.

Anonymous wrote:What am I missing here? It looks like according to Caremark 2025 prices for BCBS Standard, Wegovy is $125 for mail in and $700+ for in-store. I’ve been reading that Caremark has stopped mailing for Wegovy but according to their website it’s in stock and available through mail order (w/prior approval, etc). Is that a mistake? I’m planning to ask my PCP to prescribe to me and I’d pay $125, but am concerned they’ve eliminated the mailing option.

My weight loss doctor says Caremark is not mailing it. I have the same question/concern and if they aren't going to fill the rx they shouldn't be allowed to advertise that price.

What am I missing here? It looks like according to Caremark 2025 prices for BCBS Standard, Wegovy is $125 for mail in and $700+ for in-store. I’ve been reading that Caremark has stopped mailing for Wegovy but according to their website it’s in stock and available through mail order (w/prior approval, etc). Is that a mistake? I’m planning to ask my PCP to prescribe to me and I’d pay $125, but am concerned they’ve eliminated the mailing option.

Anonymous wrote:

Anonymous wrote:Just FYI BCBS has gotten so expensive that IMO it is not worth the cost anymore. Switched to Aetna, have been very happy and never looked back. Foreign Service Benefit Plan to be specific

Agreed!!! I wish our organization was available to do FSBP https://www.afspa.org/eligibility/ I only thought it was applicable to DoS, but I was wrong.

I've been seeing on Reddit that people are looking at GEHA (which is essentially United Health Care), MHBP (which is essentially AETNA) for cost/value/etc. MHBP has a $52 or so dues per year. I listened to an MHBP info session, and they said, of course, every insurance can change Rx tiers during the year. YMMV.

I guess it's time to do some research on all these plans and check w/ my providers if they're dropping anything. I've been on BCBS for 5+ years!

I switched to MHBP last year and I've been really happy with it. Significantly cheaper and I'm in the standard option now, not basic.