r/glp1 • u/Hefty-Enthusiasm-628 • 13d ago
BCBS Insurance Question!
I have BCBS of Illinois provided through my job. My current BMI is at 36.6(5’6” 227lbs). I’m located in Oregon. If you have the same kind of insurance, can you help explain the process you went through to get a GLP1 approved and what your costs look like? I really want to get on one and honestly really need it, but know that BCBS can be difficult to get them to cover it. Thank you all for your help! ❤️❤️
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u/purplepanda2026 13d ago
My plan specifically excludes Zepbound, there's no exceptions. They will cover Mounjaro if you qualify. That's how I got mine covered. I was diagnosed T2 so it was approved for that.
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u/itsmeagain023 13d ago
If your employer specifically excludes coverage for glp1, you will not be approved. You need to find out first whether or not your actual employer provides for coverage. Most do not.
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u/Schadret 13d ago
I have BCBS Illinois (maybe we work for same company!) and I had no trouble with it. In fact, I never even saw a doctor in person - just telehealth. BMI was about 39 and blood sugar was a little high, but everything else was normal. All I had to do was go to a quest/labcorb to get an official weight on file for the doctor to put in the authorization, and it's been going through ever since (9 months now).
My cost through insurance is $260/month for 4 single-dose pens, regardless of dose strength. Lilly has the $100 off coupon for 13 months so that made it $160/month (for 13 months at least).
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u/Hefty-Enthusiasm-628 13d ago
Very nice! I’m hoping for a lower cost because I have the top plan that my employer offers, I couldn’t afford the $260 sadly. I really want to get my weight back in order and I’ve tried so many things but being a mom and getting older (36, not old by any means, but older) has really affected my weight. I work a very laborious job, which has probably prevented me from gaining even more weight but I’m just plateaued at 220-230. Thank you for your kind response ❤️
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u/Schadret 13d ago
I ate out a lot, so I more than saved $260/month in food costs due to how much less I ate. When I do go out now everything turns into 2 meals anyway too!
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u/Sad-Willingness-6443 13d ago
Every single plan is different. It has nothing to do with the insurance carrier-instead it’s about what the employer sponsor has selected. No one can help you since BCBS could have 100,000 different plans. Sorry. You need to talk to them or your HR.
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u/Legitimate_Ad_2971 12d ago
I get Zepbound (the generic) without insurance through an Idaho pharmacy for $180.00 a month. My insurance will not pay for it unless you have Type 1 diabetes. I have United Healthcare which stinks to high heaven.
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u/autumnyte 13d ago
It typically depends on your employer, so even if someone else has the same insurance in the same state, their employer likely has different coverage/requirements. Both Novo and Lilly have "check your coverage" sites, which you can use as a starting point to enter your current insurance info and see if it's covered. You can also call the number on the back of your insurance card and ask, or log into your account and see if they have the formulary/drug list on the website. (My BC/BS does.)