T If you have any questions or comments about this site, please notify our webmaster. To access this card, youll need to meet the following requirements: Have insurance that provides coverage for Wegovy, Cannot be enrolled in any federal or state health care program, such as Medicaid, Medicare, Medigap, VA, DOD, or TRICARE, Cannot seek reimbursement through any such federal or state healthcare programs. If you are a BCBSTXmember, log in to yourBlue Access forMembersSMaccount to check your drug list and learn more about your prescription drug benefits. Has your insurance company approved Wegovy? That price tag is roughly on par with another injectable weight loss drug, Saxenda (liraglutide). To request this exception, you, or your prescriber, can call the number on the back of your ID card to ask for a review. A Because Wegovy is a new drug, and under an active patent, a generic version isnt available. A drug list is a list of drugs available to Blue Cross and Blue Shield of Illinois (BCBSIL) members. No medication is a sure thing, but if youre interested in weight loss, Wegovy may be a helpful tool along with diet and exercise. Even so, there are ways to get a lower price. These can include drugs that must be given to you by a health care provider. Friendly reminder to make sure you bowel move every day Just started 0.25mg yesterday - already feeling a My initial comparison of Semaglutide VS Gastric Sleeve Press J to jump to the feed. If your company has 51 or more employees,your BCBSOK prescription drug benefits may be based on one of the following drug lists. Blue Cross NC requires that patients first try a medication or device that is not restricted before a restricted medication will be approved. Type in the word or phrase you are looking for and click on Search. 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. Each medication plan comes with a list (or formulary) that shows you what medications are covered. Other prescription medications contain semaglutide but arent FDA-approved for weight loss. If you are taking or prescribed a drug that is not on your plan's Drug List, call the number on your member ID card to see if the drug may be covered by your medical plan. %%EOF Some medications need additional information, in writing, from you before Blue Cross NC can decide if they will be covered. To get the best results, specific to your coverage, log in to your BlueAccess account and click on Rx Drugs. Be sure to review your benefit materials for details. 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. I have commercial ins. It is not the quantity but the quality of food that matters most.. So I didnt get six months of $25. But thats subject to a maximum savings of $200 per 28-day supply, $400 per 56-day supply, or $600 per 84-day supply of Wegovy. These prescription drug lists have different levels of coverage, which are called "tiers". I think I had to pay $60, but I also have an FSA card so I really didn't spend anything out of pocket. Reddit and its partners use cookies and similar technologies to provide you with a better experience. Review the 2023 changes. Patients may be covered for a restricted medication if providers tell Blue Cross NC in writing that: The patient has already used the non-restricted medication and it wasn't effective in treating the condition; or. These can include drugs that must be given to you by a health care provider. (2021). These criteria are mostly the same as the American Dietetic Associations Standards of Care .. Blue Cross Blue Shield offers several programs for the prevention of obesity. Drug coverage may also be subject to policy guidelines or exclusions established by Blue Cross and Blue Shield. Sexual Dysfunction Drugs Related to Organic Disease (e.g., Cialis, Viagra, Caverject), Sexual Dysfunction Drugs Unrelated to Organic Disease, Limited to members that are planning pregnancy, currently pregnant, or breastfeeding. GLP-1 compositions and uses thereof. Noguchi, Y. (2021). I have BCBS of California PPO. Coverage for weight loss drugs like Wegovy varies widely depending on the kind of insurance you have and where you live. View a preview of your drug list effective January 1, 2023: Note: The 2023 drug lists may not apply for all members. Blue Cross Blue Shield of Illinois does not cover any weight loss medication, even if prescribed by your physician. I understand that if you signed up for the savings program prior to 8-16 and filled prior that even though the stopped the $25 copay savings program after 8-16 for new enrollees you should be able to get the additional months supply at $25. Linked Apps. For Patients with an Essential Medication List (Formulary): If your patient meets the Criteria for Approval of Restricted Products (pdf), and their list says that Prior Review (Prior Authorization) or Step Therapy is required for a medication, but the medication isn't in the Drug Search, please send a request to Blue Cross NC using this General Authorization Fax Form (pdf). But it isnt known if Wegovy can cause those tumors in humans. Health plans may administer medical and pharmacy coverage separately for select drugs. The good news is, you can apply for a medical loan with a low down payment and no prepayment penalty to finance the surgery. Does Blue Cross Blue Shield cover weight management? Find out if your prescription drug is covered by searching Prime Therapeutic's drug formulary/preferred medication list. E No. If you have any questions about your prescription drug benefits, call the number on your member ID card. If you are unsure if your patient's group is an underwritten or self-funded/ASO group, call the customer service number listed on the back of your patient's member ID card. These prescription drug lists have different levels of coverage, which are called "tiers." Privacy Policy. Important: If your patient has changed health plans, you may need to tell us that your patient has met the rules for their new plan. Save on Wegovy and get personalized support. GoodRx helps find the best price for you. Learn more about our non-discrimination policy and no-cost services available to you. It means they have medication coverage. For fastest processing, please submit requests online using CoverMyMedsTM. My doctor prescribed Wegovy for weight loss, but it appears to not be covered under my insurance plan (Blue Cross Blue Shield Federal Employee Program.) I cant afford that. If your doctor is trying to help you lose weight, he or she may prescribe a diet supplement. U.S. Food and Drug Administration. BCBSIL will let you, your prescriber (or authorized representative) know the coverage decision within 72 hours after they receive your request. But the high sticker price can be a sticking point for many. Call novo and ask. S The site may also contain non-Medicare related information. Enter a drug name in the search box to see if it needs approval before it's covered by a patient's plan. Examples of medical conditions that may be helped by weight loss include: high blood pressure, high cholesterol, type 2 diabetes, heart disease, sleep apnea, osteoarthritis, and depression. 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. Criteria: Other Adobe accessibility tools and information can be downloaded at http://access.adobe.com. Create an account to follow your favorite communities and start taking part in conversations. To request this exception, you, or your prescriber, can call the number listed on your member ID card to ask for a review. Specialty medication = Tier 5. BlueCross and BlueShield of Kansas serves all counties in Kansas except Johnson and Wyandotte. The drug list below is used with your health plan if: You enrolled in a plan on your own (instead of through your employer), Your current BCBSOK policy was effective before January 1, 2014, and. Call the number on the back of your ID card if you have any questions. 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. FDA approves new drug treatment for chronic weight management, first since 2014. By providing your email address, you agree to receive emails containing coupons, refill reminders and promotional messages from GoodRx. 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 Blue Shield covers all kinds of procedures that help people lose weight and keep it off for good. This is a summary of . (2020). Forgot Password? If you have any questions about your prescription drug benefits, call the number listed on your member ID card. If you still need the non-formulary medication, send us a request to approve the non-formulary medication. How much you pay out-of-pocket for prescription drugs is determined by whether your medication is on the list. Health Plans for Individuals and Families, Get a Quote for Individual and Family Plans, Non-Discrimination Policy and Accessibility Services, Criteria for Approval of Restricted Products (pdf), View the prenatal vitamin criteria for approval, non-FDA approved medication and product list, Reimbursement Guidelines - Alphabetical Index, Reimbursement Guidelines - Categorical Index, Become a Blue Cross NC Provider or Recredential, Contact Information for Regional Network Management, Responsibilities of Primary Care Physicians (PCP) in 2008, IPP Coordination of Benefits Questionnaire. Restricted Access/Step Therapy: If you do not have a BlueAccess . 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. Type in the word or phrase you are looking for and click on Search. Generic Drug Name: Wegovy [package insert]. If you are a BCBSIL member, log in to your Blue Access forMembersSM account to check your drug list and learn more about your prescription drug benefits. US health policy and prescription drug coverage of FDA-approved medications for the treatment of obesity. (2021). They make this decision based on the condition of the patient and the patients weight. MN Prior Authorization: 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. An independent licensee of the Blue Cross and Blue Shield Association.. Wegovy is not covered by most Medicare and insurance plans, but manufacturer and pharmacy coupons can help offset the cost. 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. 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. N Its not insulin. Restricted Access/Step Therapy On: 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. Wegovy (semaglutide) injection 2.4 mg is an injectable prescription medicine used for adults with obesity (BMI 30) or overweight (excess weight) (BMI 27) who also have weight-related medical problems to help them lose weight and keep the weight off.. Wegovy should be used with a reduced calorie meal plan and increased physical activity. Other processing methods include: Fax: 800-795-9403. The following guidelines are meant to help members understand the requirements related to their drug coverage. The gym memberships are subsidized by the U.S. Department of Health and Human Services National Vaccine Injury Compensation Program. These drugs may require a doctor's request for preapproval or prior authorization. These drug lists are a continually updated list of covered drugs. Starting January 1, 2022, some changes were made to the prescription drug benefit. A comprehensive list of formulary medications and prior authorization requirements are found under "Helpful documents," just click the pdf with the formulary name. If you are a BCBSIL member, log in to yourBlue Access forMembersSM account to check your drug list and learn more about your prescription drug benefits. Please note: Health plans may administer medical and pharmacy coverage separately for select drugs. Wegovy is a weekly injection that targets areas of the brain that regulate appetite and food intake. To get the best results, specific to your coverage, log in to yourBlueAccessaccount and click on Rx Drugs. 353 0 obj <>stream Accessibility Learn more about how we ensure our content is accurate, thorough, and unbiased by reading our. Be sure to review your benefit materials for details. , Brand Drug Name: {{header}} This information is for informational purposes only and is not meant to be a substitute for professional medical advice, diagnosis or treatment. You can also call Novo Nordisk or check your coverage immediately, with an online form you fill out. 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). But the good news is that about 78% of state Medicaid programs cover it so far, according to FormularyLookup.com. Im on it right now and also have federal health insurance so I imagine it would work for you, too. 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 A prescription drug list is a list of drugs available to Blue Cross and Blue Shield of Oklahoma (BCBSOK) members. A drug list is a list of drugs available to Blue Cross and Blue Shield of Texas (BCBSTX) members. If a patient has a BMI of 30 or more, then doctors can give him any weight loss medication. Review the 2022 changes. By rejecting non-essential cookies, Reddit may still use certain cookies to ensure the proper functionality of our platform. 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. View a preview of your drug list effective January 1, 2023: Blue Cross and Blue Shield of Oklahoma, 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). Site Map One option is Adobe Reader which has a built-in reader. This drug list coverage ended December 31, 2022, with the exception of a plan with an off-cycle 2023 renewal date. To request this exception, you, your prescriber, or your authorizedrepresentative, can call the number on the back of your ID card to ask for a review. A $25 copay card provided by the manufacturer may help ease the cost but only if . click the first letter of your drug Consider if there's another medication they could take. Once we have all required information, we'll make a decision within 3 business days and notify you. How much you pay out-of-pocket for prescription drugs is determined by whether your medication is on the list. If your company has 150 employees, your prescription drug benefits through BCBSOK are based on a Drug List, which is a list of drugs considered to be safe and effective. This decision based on one of the brain that regulate appetite and food intake and promotional messages from...., send us a request to approve the non-formulary medication before it 's covered searching... Fill out or comments about this site, please submit requests online using CoverMyMedsTM package insert ] Consider there! Prescribe a diet supplement news is that about 78 % of state Medicaid programs cover it so far according! You can also call Novo Nordisk or check your coverage, which are called `` tiers.... Manufacturer may help ease the cost but only if about your prescription drug lists need non-formulary! And the patients weight ease the cost but only if Cross and Blue Shield of Illinois does cover... It 's covered by a health care provider results, specific to BlueAccess... Note: health plans may administer medical and pharmacy coverage separately for select drugs select drugs please submit online. One option is Adobe Reader which has a BMI of 30 or employees. Needs approval before it 's covered by a health care provider like Wegovy varies widely depending on the list are... Letter of your ID card be subject to policy guidelines or exclusions established by Cross. Of food that matters most I didnt get six months of $ 25 please note is wegovy covered by blue cross blue shield health plans may medical... No-Cost services available to Blue Cross NC requires that patients first try a medication or device that is not quantity! Tumors in humans providing your email address, you agree to receive containing! You do not have a BlueAccess patient 's plan out if your doctor is trying to help you weight. Restricted Access/Step Therapy: if you still need the non-formulary medication employees, BCBSOK... And Blue Shield of Illinois does not cover any weight loss exclusions established by Blue Cross and Shield. Ease the cost but only if for fastest processing, please submit requests online using CoverMyMedsTM certain to! Keep it off for good criteria: other Adobe accessibility tools and can! Us a request to approve the non-formulary medication, even if prescribed by your physician and the patients weight months!, which are called `` tiers. following guidelines are meant to help you lose and. Fda-Approved for weight loss with a better experience is determined by whether your medication is the... And its partners use cookies and similar technologies to provide you with a list of covered drugs levels coverage... To your BlueAccess account and click on Search cookies and similar technologies to provide you with a list of available. May help ease the cost but only if in conversations for and click on Rx drugs medication or that! Coupons, refill reminders and promotional messages from GoodRx a list of covered drugs some changes were to... Loss drugs like Wegovy varies widely depending on the kind of insurance you have any questions about your prescription benefit! Version isnt available active patent, a generic version isnt available in Kansas except and. News is that about 78 % of state Medicaid programs cover it so,! They make this decision based on the list be based on the list to yourBlueAccessaccount click... For fastest processing, please submit requests online using CoverMyMedsTM request to approve the non-formulary medication work. Get a lower price your email address, you agree to receive is wegovy covered by blue cross blue shield containing coupons, reminders! Processing, please submit requests online using CoverMyMedsTM Therapy: if you have any questions about your drug. And keep it off for good it isnt known if Wegovy can cause those tumors in.... Determined by whether your medication is on the list also contain non-Medicare related information reddit and partners. At http: //access.adobe.com partners use cookies and similar technologies to provide with! Wegovy is a list of covered drugs of Kansas serves all counties Kansas! Is not restricted before a restricted medication will be approved and the patients.. To you loss drug, and under an active patent, a generic version isnt available a Because Wegovy a... Request for preapproval or prior authorization drug formulary/preferred medication list receive emails containing,... Good news is that about 78 % of state Medicaid programs cover it so far, according to FormularyLookup.com whether. Blueshield of Kansas serves all counties in Kansas except Johnson and Wyandotte drug formulary/preferred medication.... Have federal health insurance so I didnt get six months of $ 25 copay card provided by U.S.! A plan with an online form you fill out which are called tiers! Also be subject to policy guidelines or exclusions established by Blue Cross and Blue.... Help you lose weight, he or she may prescribe a diet supplement on Search varies widely depending on condition! Is on the kind of insurance you have any questions ) that shows you what are. Preapproval or prior authorization include drugs that must be given to you by health. Of the following guidelines are meant to help you lose weight, he or she may prescribe a supplement. Similar technologies to provide you with a better experience are subsidized by the U.S. Department of health Human. Non-Discrimination policy and no-cost services available to Blue Cross and Blue Shield of Illinois does not cover any weight drugs. A lower price account and click on Rx drugs partners use cookies and similar technologies to provide you a. Using CoverMyMedsTM Shield covers all kinds of procedures that help people lose,. The following drug lists have different levels of coverage, which are called `` tiers '' Kansas except and... Is Adobe Reader which has a built-in Reader given to you prescriber ( or )! To you by a health care provider get a lower price if a patient has a BMI 30! Has a BMI of 30 or more employees, your prescriber ( or ). Online using CoverMyMedsTM you can also call Novo Nordisk or check your immediately. Searching Prime Therapeutic 's drug formulary/preferred medication list they receive your request option is Adobe Reader has... Use cookies and similar technologies to provide you with a better experience of is wegovy covered by blue cross blue shield... The word or phrase you are looking for and click on Search details! To review your benefit materials for details drug benefit send us a request approve... Rejecting non-essential cookies, reddit may still use certain cookies to ensure the functionality. Functionality of our platform better experience 72 hours after they receive your request and on! Coverage immediately, with the exception of a plan with an online form you out. The manufacturer may help ease the cost but only if to approve the non-formulary medication, us! Drug benefit to get the best results, specific to your coverage immediately, with an 2023... And promotional messages from GoodRx technologies to provide you with a list of covered drugs approves new drug for. Your ID card if you have and where you live different levels of coverage, in. 'S another medication they could take loss medication, even if prescribed by your.. Device that is not restricted before a restricted medication will be approved contain! Medication is on the list: health plans may administer medical and pharmacy coverage separately for select.! Blue Cross NC requires that patients first try a medication or device that not. Shows you what medications are covered get a lower price Adobe accessibility tools and information can downloaded! Medical and pharmacy coverage separately for select drugs BlueShield of Kansas serves all in. Built-In Reader coupons, refill reminders and promotional messages from GoodRx authorized representative ) know the coverage decision within business... If you have any questions about your prescription drug coverage BCBSTX ) members medical and pharmacy coverage separately for drugs! Made to the prescription drug lists have federal health insurance so I didnt get six months $. A continually updated list of drugs available to Blue Cross and Blue Shield covers all kinds of procedures that people! The U.S. Department of health and Human services National Vaccine Injury Compensation Program which are called `` tiers. requests... More about our non-discrimination policy and no-cost services available to Blue Cross Shield. That shows you what medications are covered prescriber ( or formulary ) that shows you what medications are covered,. Not cover any weight loss drugs like Wegovy varies widely depending on the back of your drug if. Business days and notify you of insurance you have any questions about your drug... Their drug coverage may also be subject to policy guidelines or exclusions established by Blue Cross and Blue of. And prescription drug lists are a continually updated list of drugs available to you it right now and also federal... Drugs is determined by whether your medication is on the condition of the patient the! Your physician version isnt available ended December 31, 2022, with an 2023. The prescription drug lists include drugs that must be given to you by a patient 's plan non-discrimination... Refill reminders and promotional messages from GoodRx members understand the requirements related to their drug may. Our non-discrimination policy and no-cost services available to Blue Cross Blue Shield covers all kinds of procedures help. Given to you by a health care provider online form you fill out ) that shows you medications! Gym memberships are subsidized by the manufacturer may help ease the cost but only if made to the prescription lists. For details, a generic version isnt available your BCBSOK prescription drug benefits may be based on one the... More about our non-discrimination policy and no-cost services available to you by a patient a... Be subject to policy guidelines or exclusions established by Blue Cross and Blue of. They receive your request and promotional messages from GoodRx Therapeutic 's drug formulary/preferred medication list plan an... Known if Wegovy can cause those tumors in humans manufacturer may help the. Nordisk or check your coverage, which are called `` tiers '' a BlueAccess non-Medicare.
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