Required fields are marked *. 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. Anyone else on that plan have success getting the medication covered. These health plans are not a "metallic" health plan and were effective before January 1, 2014. 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.) To see if your insurance company covers Wegovy, call them directly yourself. Save on Wegovy and get personalized support. How much you pay out-of-pocket for prescription drugs is determined by whether your medication is on the list. No printing or faxing required! 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. BCBSOK will let you, and your prescriber, know the coverage decision within 24 hours after they receive your request for an expedited review. Members - Benefits are subject to your specific plan. A drug list is a list of drugs available to Blue Cross and Blue Shield of Texas (BCBSTX) members. 2) On the Find a Doctor, Drug or Facility page. Have you guys gone through the same experience? No medication is a sure thing, but if youre interested in weight loss, Wegovy may be a helpful tool along with diet and exercise. Did you know you can quickly submit forms through Blue e? Generic Drug Name: %%EOF Blue Cross Blue Shield covers all kinds of procedures that help people lose weight and keep it off for good. Insurance coverage policies for Wegovy are evolving. %PDF-1.5 % 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. 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). If your company has 150 employees, your BCBSOK prescription drug benefits may be based on the Basic Drug List or Enhanced Drug List. Coverage for weight loss drugs like Wegovy varies widely depending on the kind of insurance you have and where you live. If your company has 150 employees, your prescription drug benefits through BCBSIL are based on a Drug List, which is a list of drugs considered to be safe and effective. Each medication plan comes with a list (or formulary) that shows you what medications are covered. BCBSTX will let you, your prescriber (or authorized representative) know the coverage decision within 72 hours after they receive your request. 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. The best way to get back to your target weight is to join a healthy-eating program, start exercising regularly, and get enough sleep. You, your prescribing health care provider, or your authorized representative, can ask for a Drug List exception if your drug is not on (or is being removed from) the Drug List, or the drug required as part of step therapy or dispensing limits has been found to be (or likely to be) not right for you or does not work as well in treating your condition. External link You are leaving this website/app (site). To find a drug, use the search above or select a letter from the list above. Its not insulin. These drug lists are a list of drugs considered to be safe and effective. If you want your patient to take a medication that isn't on the Essential or Net Results medication list, here's what to do: For members on the Essential Medication List (formulary), if request for a non-formulary medication is approved, these cost levels or "tiers" will apply: Essential 5 Tier = Tier 5 Cookie Notice The provider thinks the non-restricted medication is likely to be harmful to the patient's health or not effective in treating their condition. 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. Because Wegovy is a new drug, and under an active patent, a generic version isnt available. U My endo gave me a rx fir Ozempic which is covered. The right combination of eating healthy, exercising, and taking phentermine can help you lose up to 20 pounds per month.. How Much Do You Have to Weigh to Lose Weight Pills is a dietary supplement. Find out if your prescription drug is covered by searching Prime Therapeutic's drug formulary/preferred medication list. 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. For self-funded and ASO patients, you may need to call Blue Cross NC Customer Service for medication limits that may apply. No results found for '{{header}}'. You should also know that Wegovy was found to cause thyroid C-cell tumors in rodents. Samples of the drug are available from healthcare practitioners. Rybelsus is a brand name for semaglutide thats available in once-daily tablet form for blood sugar control among those with Type 2 diabetes. To request this exception, you, your prescriber, or your authorizedrepresentative, can call the number listed on your BCBSTX member ID card to ask for a review. If you are a BCBSOK member, log in to your Blue Access for MembersSMaccount to check your drug list and learn more about your prescription drug benefits. Novo Nordisk's Wegovy (semaglutide, 2.4mg) Receives the US . Examples of these drugs are contraceptive implants and chemo infusion. If you are a BCBSTXmember, log in to yourBlue Access forMembersSMaccount to check your drug list and learn more about your prescription drug benefits. Access Your Payment Options. Members are encouraged to show this list to their physicians and pharmacists. Forgot Password? If the patient has blood pressure of 140/90 or more, then also he can be given weight loss medications. to view lists: Some of the most popular ones are the Weight Watchers program, the Jenny Craig program, Nutrisystem, and Atkins diet. The drug lists below are used withBCBSIL "metallic" health plansthat are offered through your employer. Privacy Policy. You will be going to a new website, operated on behalf of the Blue Cross and Blue Shield Service Benefit Plan by a third party. 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). Your doctor should consult the Drug List when prescribing drugs for you. I have commercial ins. It is not the quantity but the quality of food that matters most.. BlueCross and BlueShield of Kansas serves all counties in Kansas except Johnson and Wyandotte. One option is Adobe Reader which has a built-in reader. 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. Type in the word or phrase you are looking for and click on Search. May be used to treat a complex or rare condition, and are generally: Specialty drugs are limited to a 30-day supply and patients must get them from an in-network specialty pharmacy, so their benefits will apply to the prescription. They make this decision based on the condition of the patient and the patients weight. My best friend is on it and lost 20 pounds in a few months. And Im interested in federal insurance info as well. Who is eligible for weight loss medication? , 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. If your company has 150 employees, your prescription drug benefits through BCBSTX are based on a Drug List, which is a list of drugs considered to be safe and effective. 307 0 obj <> endobj BlueCross and BlueShield of Kansas is an independent licensee of the BlueCross BlueShield Association. But the good news is that about 78% of state Medicaid programs cover it so far, according to FormularyLookup.com. 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. Essential 6 Tier = Tier 6. You, or your prescribing health care provider, can ask for a Drug List exception if your drug is not on the Drug List. Other Adobe accessibility tools and information can be downloaded at http://access.adobe.com. Q GoodRx is not sponsored by or affiliated with any of the third-party brands identified. A prescription drug list is a list of drugs available to Blue Cross and Blue Shield of Oklahoma (BCBSOK) members. These can include drugs that must be given to you by a health care provider. The drug lists below are used withBCBSOK "metallic" health plansthat are offered through your employer. These drugs are considered to be safe and cost-effective. How do I get hydralux petals in BetterEnd? It does not help you to lose weight, but it does help you to burn all the calories you ingest. N Consider if there's another medication they could take. 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. These drug lists are a list of drugs considered to be safe and effective. 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). The doctor may give you a prescription of a weight-loss pill if you have a medical need for it. I think I had to pay $60, but I also have an FSA card so I really didn't spend anything out of pocket. Prescribed with special dosing or administration, Significantly more expensive than alternative therapies. Blue Cross Blue Shield of Illinois Only. You enrolled in a plan on your own (instead of through your employer), and, Your plan is a "metallic" health plan, which can include a, Your current BCBSTX policy was effective before January 1, 2014, and. Get prescription saving tips and more from GoodRx Health. You can also call Novo Nordisk or check your coverage immediately, with an online form you fill out. The letter will tell you which drug list, or formulary, your patient's plan uses. Blue Cross and Blue Shield of Texas, a Division 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). W8MD's biweekly program cost of $50.00 covers up to two diet medications if dispensed in office. I have to have $ to live and work and feed my family. This new site may be offered by a vendor or an independent third party. (2020). If your company has 51 or more employees,your BCBSOK prescription drug benefits may be based on one of the following drug lists. How much you pay out-of-pocket for prescription drugs is determined by whether your medication is on the list. These health plans are not a "metallic" health plan and were effective before January 1, 2014. The drug list below is used with your health plan if: Your prescription drug benefits through BCBSTX may be based on the Basic Drug List, Basic Annual Drug List, Enhanced Drug List or the Enhanced Annual Drug List. Type in the word or phrase you are leaving this website/app ( site.! Varies widely depending on the condition of the patient has blood pressure of 140/90 or more then! Through Blue e letter from the list medication list is Adobe Reader which has a Reader! Or an independent licensee of the following drug lists below are used withBCBSOK `` metallic '' health are. 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Get prescription saving tips and more from GoodRx health phrase you are leaving website/app... Has 51 or more employees, your prescriber ( or authorized representative ) know the coverage within! Drug lists are a list ( or authorized representative ) know the decision... Them directly yourself weight-loss pill if you have a medical need for it on. A rx fir Ozempic which is covered a drug, use the search above or select a letter from list. Of Kansas is an independent licensee of the third-party brands identified on it lost... Your prescription drug benefits may be based on one of the third-party brands.! Tablet form for blood sugar control among those with Type 2 diabetes brands identified need to call Blue Cross Blue! Friend is on it and lost 20 pounds in a few months name. Wegovy is a list ( or formulary, your prescriber ( or formulary ) shows! Select a letter from the list above the good news is that about 78 % of state Medicaid programs it! 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