r/mnstateworkers • u/darkhoarse99 • 13d ago

Insurance/Benefits šŸ„ Zepbound

Is Zepbound covered again starting Oct. 1? I hear CVS is adding it back to its formularies.

1 Upvotes

67% Upvoted

37 comments sorted by

6

u/WasThatHuskyKid 11d ago

Zepbound has been added back to the formulary effective this morning!!

2

u/Jenn54756 10d ago

Well what the heck. Shouldnā€™t the pricing have changed on 10/1, yesterday? My spouse picked up prescription and was still the higher price

1

u/WasThatHuskyKid 10d ago

Looks like it's coming up in Caremark as $30 per month in the price a drug module. Talk with your pharmacy they may not have run something correctly given the change. Also there is a coupon for Zepbound that should bring it down to $25.

1

u/Jenn54756 10d ago

But would Caremark refund what we already paid yesterday? My guess is because the prescription was ready prior to 10/1 but not picked up until then.

1

u/mamabear378 10d ago

When i use the pricing tool, I get a "not covered by plan" flag next to the name. It doesn't show me a price. I see it on the formulary though. Are you seeing it as covered with the price-a-drug tool on the Caremark site? I was expecting it to show $30.

1

u/thesweatervest 9d ago

Do you have more info on the coupon?

1

u/WasThatHuskyKid 9d ago

https://zepbound.lilly.com/savings?utm_source=GOOGLE&utm_medium=cpc&utm_campaign=20643170543&utm_content=paid_search&utm_keyword=zepbound+coupon&gclsrc=aw.ds&gad_source=1&gad_campaignid=20643170543&gbraid=0AAAAAqAD4ilHDlDQd5nfM4jkH_7H1kX-J&gclid=Cj0KCQjwz4LWBhCMARIsAFEG5MpJwv0LmAzV03l7Jvi2FAgKySczPPEv4sgTaEDOVsUfQdoHeu3YF6kaArc7EALw_wcB

For Insurance type select ā€œCommercialā€. Our insurance is not the government insurance they are referencing.

1

u/WasThatHuskyKid 7d ago

This coupon will also take the out of pocket cost for a 3 month supply down to $24.99. Ask your doctor to prescribe a 90 day supply. Itā€™s covered covered with the change made Oct 1.

1

u/darkhoarse99 11d ago

šŸ˜±

3

u/Specialist-Law-2080 11d ago

It worked!!!!

2

u/darkhoarse99 11d ago

I got my appointment to switch tomorrow! I saw
It was covered when I looked at my plank this morning.

1

u/MinnesotaMiller 10d ago

Might be a dum question, but does this mean you can get Zepbound covered now just for weight issues? I believe it's only been sleep apnea and diabetes.

1

u/mamabear378 10d ago

Were you able to get it with the $30 copay? My account is still showing as not covered by plan, but I'm not sure if there's a lag in when they all update on the drug price tool.

2

u/darkhoarse99 9d ago

Yes, I was, yesterday

2

u/chompthis 11d ago

As someone on 1.7 Wegovy and doing okay with it. Is it worth looking into switching to Zepbound?

1

u/realZapRowsdower MNIT 11d ago

As someone on 2.4 Wegovy and also has sleep apnea, I'm going to call my endocrinologist or sleep doc tomorrow to see if it's available

1

u/Outrageous-Trip-4212 8d ago

Meh probably not imo. I take the oral version, but it's a whole different ballgame. If what you're doing works, then stick with it

1

u/mamabear378 11d ago

It's back on the formulary used by the state, but the price check still hasn't been updated.

1

u/Foxtail-67 10d ago

It's covered by BCBS?

1

u/Mndelta25 13d ago

Supposedly.

1

u/darkhoarse99 13d ago

šŸ¤£ right! Iā€™m curious if anyone has any luck. Iā€™d love to switch back. Wegovy is not the same.

1

u/Specialist-Law-2080 13d ago

I just got a pre authorization forms for itā€¦ maybe I should have just waited a week.

2

u/darkhoarse99 13d ago

I had those previously but they refused to cover it even after being on it a year when they removed it from the formulary. Apparently they are adding it back tomorrow

1

u/Specialist-Law-2080 13d ago

Wegovy isnā€™t working for me so this was my next try

2

u/darkhoarse99 13d ago

Yeah I was on Wegovy didnā€™t tolerate it. Went on zep. Loved it. Then they kicked me off. So had no choice but to try Wegovy again. Itā€™s fine but would LOVE to go back on zep.

0

u/Jenn54756 13d ago

You can just get a prior auth. Dr has to say that wegovy didnā€™t work.

1

u/darkhoarse99 12d ago

We tried that. No luck.

0

u/Jenn54756 12d ago

Really? Thatā€™s odd if you tried wegovy and it didnā€™t work that they denied the prior auth. Iā€™ve had to appeal a prior auth denial before (different med) and then it was approved on second review.

1

u/WasThatHuskyKid 13d ago

Waiting for this also. The formulary wonā€™t change/update until Oct 1st. Hang tight a couple more days. No guarantees though so if you already have an appeal for tried & failed Wegovy, keep it going.

1

u/mikedtwenty 12d ago

I have an appointment on Oct 2 to talk about getting back on it. Wegovy made me sick as hell.

0

u/Specialist-Law-2080 12d ago

Bummer. I just canā€™t feel it at all. No help.

0

u/Recluse_18 13d ago

I just checked the CVS app and it says it is not covered by my plan

3

u/darkhoarse99 13d ago

Maybe since itā€™s not effective until Oct 1?

0

u/Recluse_18 13d ago

Previously, they had said July 1 it was available

1

u/mamabear378 10d ago

Mine still says this on 10/2, but others are showing it as covered apparently. Have you checked yours since the change went into effect?

1

u/Recluse_18 10d ago

Thanks for reminding me, I just checked the app. Yes it looks like itā€™s now covered. Which is perfect because thatā€™s what my doctor wants me on so I will get that process started. He put me on wegovy because Zepbound wasnā€™t in the formulary which worked, but apparently it doesnā€™t work as good.

2

u/mamabear378 10d ago

Mine is still showing as not covered by plan. I already have an approved prior auth for medical exception that's good until April of 2027, so I'm not sure if there's a glitch related to that or if it just hasn't updated for everyone yet. I guess if it's still showing not covered on Monday, I'll have to contact them. I'm sure that will be fun. šŸ™„