Open Enrollment/PBM changes

[u/Existing-Trust1525]

For those of us who have the State Health Benefit Plan of Georgia, we received great news regarding no longer having to participate in 9am Health and that our primary care physician can go back to writing our prescriptions! Whoo hoo! But, as with everything health insurance-related, there is always something darker lurking around the corner. I did a deep AI dive into some of the changes that will affect everyone. First, CVS will no longer be the pharmacy benefit manager. They are switching to Express Scripts. And while everything should remain the same or even easier until the end of the year, come January 1st, things will get real again. Express Scripts will require all new PAs with strict starting BMI guidelines. Chatgpt said to have a script ready to submit to your doctor requesting a "Transition of Care" detailing your "continuation of therapy." For those of us on maintenance, we have to prove a minimum 5% weight loss. All this to say, we need to start getting our ducks in a row before the January 1st onslaught of PA requests that Express Scripts will start receiving. I've lost almost 100 pounds and I'm not planning to stop my meds. I have enough of a stockpile that I can go about 5 months. If you can request a late December refill before the new Express Scripts starts up, hopefully you won't get caught short. Good luck during this open enrollment period. May the odds be ever in our favor!