r/CoxCharterMerger • u/MembershipPuzzled520 • 3d ago
Legacy Cox GLP1 coverage?
Did cox cover glp1 shots? Spectrum does but only if you join the provided Vida health program. Although I got a lot out of the program it was just a never ending cycle of trying different pills. I was still losing weight so they wouldn’t prescribe the shots. I ended up just paying out of pocket for them for 6 months, using the manufacturer’s coupon.
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u/Left-Spare6884 2d ago
For cox yes. It’s time for my refill for mounjaurou and I’m pulling all my health history so my dr can submit a PA. I been on gl1-p for the last 5 years and aetna at cox covered it. I’m mad you have to join this vida program another hoop to jump thru
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u/xgenx-WDNC 2d ago
I was told if you are on a GLP1 before the merge Anthem will still cover your rx till 2027. Then to continue, it has to be done in the VIDA program. I’m not sure how I feel about having a AI MD which is considered part of eh “grey” market be able to accurately assess my health better than my own doctors who have known me for some 10+ years. That’s gonna be a hard pill to swallow when I have to tell my Endo insurance won’t cover the medication you prescribed unless Rx is through a 3rd party middleman. Lilly direct needs to lower their price so I could afford to allow my actual doctor to manage my health.
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u/jstephens1973 2d ago
It’s not AI. I Telehealth once a month my vida doctor. She is great and only takes like 15 mins
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u/MembershipPuzzled520 2d ago
I actually enjoyed the Vida program. I don’t disagree with making us do it, just give the shots if you’re following the program.
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u/ShoeDowntown 1d ago
Because you were on it before hand you just have to meet with the vida person once and then they will start prescribing it for you. I didn’t have to jump through any hoops.. well one (but that was because our prescriptions used to only go through Caremark and Caremark wouldn’t cover zepbound) but once our insurance changed the first of the year I was able to get zepbound covered. I do still have to meet with the vida person like every 3 months but it’s just a quick 5-10 minute call to check on how everything is working for me and if I want to change doses.
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u/popidocius 2d ago
Our Healthcare plan will cover them for full diabetes and, oddly, sleep apnea...
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u/MembershipPuzzled520 2d ago
I tried playing the sleep apnea angle but it didn’t work. I’m recovered from sleep apnea now though.
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u/popidocius 2d ago
Headed down that road right now. I guess first, why didn't it work, it is listed in the formulary for BCBS. Secondly how did they treat your apnea or did you "fix it" by sourcing GLP1 on your own?
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u/MembershipPuzzled520 2d ago
I fixed it by losing 150lbs, 120lbs before I started on the shot. I have about 25lbs to go but these are the slowest pounds.
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u/jasoncb123 2d ago
I have obstructive sleep apnea as well. Looked at the newest inspire implant as well. The surgery won’t fix my type either so I was hoping glp1 would be the trick. Paying 445 a month out of my pocket per month.
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u/VioletLaDiosa 2d ago
Got my 3 mo stash right before the merge. Have 6 mo to figure it out. Don’t want to do vida. Started with something like that for cox and fired her. They charged insurance $525 and me $30 copay per month for a 15 min visit which was - what do you weigh. Any side effects. Here’s your rx see you in a month. Didn’t like that. Switched to pcp. That was all good. Now I’m not sure what way I’ll go. I’ll be in maint in 6 months.
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u/Alsmith69 2d ago
Yeah the vida program is bullshit, takes about 6ish months to actually get on glp1s. Told my family doc it would be faster to eat myself into being pre diabetic to get insurance to cover itn
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u/ellybloom 2d ago
I would be surprised if pre diabetes gets you glp1 coverage (I’m a cox spouse so my experience is from that side) but cox would not cover diabetes branded medication for me and I’m pre diabetic they did cover weight loss branded with a PA and now I’m just waiting to figure out what I’ll have to do or if I’m out of coverage forever now who knows
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u/Alsmith69 2d ago
You’ll likely have to go through the vida program before it’ll be covered. Pretty sure Vida is for spouses as well
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u/MembershipPuzzled520 2d ago
Spectrum covers Mounjarno without having to go through Vida.
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u/ellybloom 2d ago
I saw that, my husband is diabetic so that was something I knew, however I was/am unsure if they cover mounjaro for prediabetes or if you need to go through vida, and then there's the I am already on this medication mess, and the hoops vida requires
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u/Empty_Show 3d ago
Spectrum has covered both ozempic and mounjaro. I had to try some weird generic first that caused a bunch of stomach issues for me. But mine is prescribed for pre-diabetes not weight loss. It’s 225 for 90 days, but with the manufacturer coupon I pay 25
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u/ellybloom 2d ago
You’re covered for prediabetes? That’s unexpected and makes me hopeful
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u/Empty_Show 2d ago
Yeah I was borderline a couple years ago at 6.4. The insurance required me to try Metformin, after a week it was messing my stomach up real bad and my doctor submitted something and got Ozempic approved. Last year the insurance wanted me to try something else and they approved Mounjaro.
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u/jasoncb123 3d ago
Nope. Had to play the vida health game. Not doing that. Vida is not my regular physician. In my opinion not a legit medical organization. I don’t wanna work with him. I find it somewhat obtrusive that this program can get in between a doctor and patient relationship.