L Mail: Blue Cross NC, Attn: Corporate Pharmacy, PO Box 2291, Durham, NC 27707. The lowest GoodRx price for the most common version of Wegovy is around $1,318.90, 16% off the average retail price of $1,576.73. J The Table of Drugs with Limited or No Coverage shows a sample listing. The following guidelines are meant to help members understand the requirements related to their drug coverage. At this point Im on BCBS anthem and they denied my Prior authorization. Qualified through high BMI and elevated cholesterol. The site may also contain non-Medicare related information. The site may also contain non-Medicare related information. Returning Shopper? V Does Blue Cross Blue Shield cover weight management? I was declined because they want you to have a BMI of 45 + or BMI of 35 with comorbidities. If you believe you should qualify for an exception, please have your provider, Non-Food and Drug Administration (FDA) Approved Drugs, Prescription medications with over-the-counter (OTC) alternatives, Single claims over $10,000 require prior authorization (excluding antivirals, anti-infectives, anti-convulsants, insulin, specialty medications, and medications already subject to Prior Authorization or Step Therapy requirements). Although plan designs can vary, most Medicare Part D plans have a cost sharing component commonly known as a coverage gap or "donut hole.". hbbd``b`$gX'$XXe V=` 4@d No. Blue Cross and Blue Shield of Texas October 2022 Performance Drug List I Introduction Blue Cross and Blue Shield of Texas (BCBSTX) is pleased to present the 2022 Drug List. Does anyone know if the choices of plans offered pay for obesity meds? How much you may pay out-of-pocket for prescription drugs is determined by whether your medication is on the Drug List. Another Novo Nordisk drug, Ozempic, a Type 2 diabetes medication approved to help control blood sugar, also contains semaglutide but at a lower dose than Wegovy. Does Blue Cross Blue Shield Cover Weight Loss Medication? As an example, someone whose starting weight was 220 pounds would have lost an average of 27 pounds while taking Wegovy. If the coverage request is denied, BCBSTX will let you and your prescriber (or authorized representative) know why it was denied and offer you a covered alternative drug (if applicable). If you are a BCBSOKmember, log in to yourBlue Access for MembersSMaccount to check your drug list and learn more about your prescription drug benefits. You can usually find the phone number on the back of your insurance card. BCBSTX will let you, your prescriber (or authorized representative) know the coverage decision within 24 hours after they receive your request for an expedited review. Each medication plan comes with a list (or formulary) that shows you what medications are covered. Be sure to review your benefit materials for details. Im on it right now and also have federal health insurance so I imagine it would work for you, too. MOVE! BCBSOK will let you, and your prescriber, know the coverage decision within 24 hours after they receive your request for an expedited review. that are offered through your employer. US health policy and prescription drug coverage of FDA-approved medications for the treatment of obesity. Who is eligible for weight loss medication? The drug lists below are used for BCBSIL health plans that are offered through your employer. A non-formulary medication is one that isn't on a patient's Blue Cross NC medication list. Your copay may be reduced to as little as $25 per month for up to six fills, with maximum savings of $200 per 28-day supply. And, based on the law that sets patent terms at 20 years, there probably wont be one for quite a while. Other Adobe accessibility tools and information can be downloaded at http://access.adobe.com. www.wegovy.com/saving-and-support/save-and-support.html, 30-day supply (120-mg capsules 3 times per day), 28-day supply (3-mg injection once per day), It varies. If your usual copay is more than $25, youd be saving money by using the copay card at a participating retail pharmacy. Inscribirse ahora! Review the 2022 changes. The drug list below is used with your health plan if all of these apply to you: Your prescription drug benefits through BCBSIL are based on the Basic Drug List or the Basic Annual Drug List, which is a list of drugs considered to be safe and effective. The Jenny Craig program is probably one of the best, because it has a counselor for you that will teach you how to eat healthy, exercise, and how to maintain your weight throughout your life.. With the advent of fitter and healthier heart, Blue Cross has taken a note and is offering gym memberships. If you still need the non-formulary medication, send us a request to approve the non-formulary medication. For the $25 dollar for up to 6 months: I just called novonordisk and they said that insurance still has to pay for some of it. I have Blue Cross Blue Shield FEP (federal employee program) health insurance. BlueCross and BlueShield of Kansas is an independent licensee of the BlueCross BlueShield Association. Bonus: for any feds out there, which one of the insurances we sign up for at open enrollment do you have that covers weight loss drugs? A prescription drug list is a list of drugs available to Blue Cross and Blue Shield of Oklahoma (BCBSOK) members. Blue Cross Blue Shield covers all kinds of procedures that help people lose weight and keep it off for good. Prior Review Required On: O Does Blue Cross Blue Shield Florida cover weight loss programs? However a tummy tuck surgery can be expensive and many people wonder if they will have to pay for it out of their own pockets. Reddit and its partners use cookies and similar technologies to provide you with a better experience. Coverage Criteria: 1. Reddit and its partners use cookies and similar technologies to provide you with a better experience. Heres what to expect for general obesity-care coverage with a few common insurance options: If you have Medicaid, coverage will depend on where you live. These can includePlatinum, Gold, Silver, or Bronzeplans. After successful clinical trials, Wegovy (semaglutide) earned FDA approval for weight loss, making it the first drug of its kind to get that status since 2014. Not all limited medications are listed. If the medication is listed in the Drug Search, use the fax form shown there. Essential 6 Tier = Tier 6. Yep.. These prescription drug lists have different levels of coverage, which are called tiers. Otherwise they will only give $200 off of the whole price. Restricted Access/Step Therapy On: Most PDF readers are a free download. Work for one of the most trusted companies in Kansas. Wegovy. Establishment of TRICARE Select and other TRICARE reforms. Wegovys retail cost for a one-month supply is around $1,627. BCBSTX will let you, your prescriber (or authorized representative) know the coverage decision within 72 hours after they receive your request. To view this file, you may need to install a PDF reader program. Have you guys gone through the same experience? These prescription drug lists have different levels of . Cookie Notice To request this exception, you, your prescriber, or your authorized representative, can call the number on the back of your ID card to ask for a review. Review the 2023 changes. Y Call novo and ask. Olvido su contrasea? Note: Criteria: Pharmacy Operations: (800)366-7778 You must send all the details, with your signature, to Blue Cross NC. I have to have $ to live and work and feed my family. To encourage the proper use of prescription medications, Blue Cross NC may restrict the amount of medicine an insurance plan covers. Also, any medication-specific clinical criteria must be met before approval (available in the Drug Search). Once we have all required information, we'll make a decision within 3 business days and notify you. . So 1465.00. These drug lists are a continually updated list of covered drugs. These drug lists are a list of drugs considered to be safe and effective. Im not sure if other Blue Cross Blue Shield affiliates cover medication, but I would check with your specific plan before ordering any.. Blue Cross Blue Shield will cover weight management, as long as the patient has a medical condition that is likely to be helped by weight management. Pharmacist called novo himself. These can include drugs that must be given to you by a health care provider. Enter a drug name in the search box to see if it needs approval before it's covered by a patient's plan. Learn More. The gym memberships are subsidized by the U.S. Department of Health and Human Services National Vaccine Injury Compensation Program. If you have a health condition that may jeopardize your life, health or keep you from regaining function, or your current drug therapy uses a non-covered drug, you, your prescriber, or your authorized representative, may be able to ask for an expedited review process. This new site may be offered by a vendor or an independent third party. 2023 Blue Cross and Blue Shield of North Carolina. A drug list is a list of drugs available to Blue Cross and Blue Shield of Texas (BCBSTX) members. Different pharmacies offer different prices for the same medication. These drug lists are a list of drugs considered to be safe and effective. Please list the company here and tell your story of getting it approved. If the coverage request is denied, BCBSIL will let you and your prescriber (or authorized representative) know why it was denied and offer you a covered alternative drug (if applicable). Wegovy also doesnt have a generic equivalent, meaning Novo Nordisk can set whichever price it likes. If the coverage request is denied, BCBSOK will let you and your prescriber know why it was deniedand offer you a covered alternative drug (if applicable). I would also like to sign up for a free GoodRx account, Written by Julie Adkison, PharmD, BCACP, CDCES. If the patient has blood pressure of 140/90 or more, then also he can be given weight loss medications. Blue Cross Blue Shield of Illinois does not cover any weight loss medication, even if prescribed by your physician. Generic Drug Name: I am 65, trying either to switch plans at open enrollment. Some medications may not be covered by the patient's plan or may have a limited amount the patient can receive. The drug lists below are used withBCBSTX"metallic" health plansthat are offered through your employer. I dont want to spend a thousand a month or whatever the high price is.. what options are left? Search by drug name:Search The drug lists below are used with your health plan if: Your prescription drug benefits through BCBSTX are based on a Drug List, which is a list of drugs considered to be safe and cost-effective. Our drug search tool shows the restricted medications our members use most, the requirements for approval, and the details you must send us to get them approved. Blue Cross and Blue Shield of Illinois, aDivision of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association, PDF File is in portable document format (PDF). BlueCross and BlueShield of Kansas serves all counties in Kansas except Johnson and Wyandotte. View theCommonly Prescribed Maintenance Drug List (These are drugs taken regularly for an ongoing condition). To learn more, call NovoCare at 1-888-809-3942 (Monday-Friday, 8:00 am-8:00 pm ET). 327 0 obj <>/Filter/FlateDecode/ID[<128E3FB9C61E2446975B9A9CF4B79EA9>]/Index[307 47]/Info 306 0 R/Length 97/Prev 60398/Root 308 0 R/Size 354/Type/XRef/W[1 2 1]>>stream If all details are submitted online and the request is approved, the member may be able to pick up their prescriptions at the pharmacy in less than 2 hours. In addition, some sites may require you to agree to their terms of use and privacy policy. 1. In these cases, the weight loss plan offered by the physician should be medically supervised. To search for a drug name within the PDF Drug List document, use the Control and F keys on your keyboard, or go to Edit in the drop-down menu and select Find/Search. Wegovy launched in late June and is available in pharmacies throughout the U.S. for those with a prescription. So until my insurance will help Im done with it. If the coverage request is denied, BCBSIL will let you and your prescriber (or authorized representative) know why it was denied and offer you a covered alternative drug (if applicable).