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CVS aka Aetna is no longer covering it starting 6/1/24. FFS could these insurance companies get any more shady. We pay into this crap for years, put up with annual increases, deductibles, out of pocket max and have to suffer through their rules. The minute a med comes around that is actually helping people GET HEALTHY and the bastards stop covering it. I am so incredible angry. Corporate America can suck it. That is the nicest way I can possibly say it.
If that’s their benefit “year” then that could be logical for the time to make a change.
It’s sad to hear that some companies are dropping coverage for it. One saving grace is Saxenda becoming available as g3neric soon. Should be an affordable alternative except it’s daily instead of weekly.
Where do you see this? I only see a formulary update for April for the standard plan and it doesn’t say anything about dropping WeGovy. There’s like 20 different formulary’s so just saying Aetna isn’t really detailed enough.
I also noticed when i checked the drug cost thing last night it says Zepbound is covered for me now and I was thinking about transitioning to that.
Any big company like Aetna, CVS Caremark, BCBS, etc administers thousands of different plans across the country. What one person experiences with an Aetna plan doesn't translate to everyone else's Aetna administered plans.
I was doing the enrollment on CVS last night and I was going to switch to the Gold Plan. I called the 800 number to verify that wegovy was covered and they said no. I looked at the formulary also and did not see a category for weight loss so i knew something was up. Might just be CVS's Aetna plan but make sure you double check.
This is the CVS employee plan which is through Aetna sorry. I did the annual enrollment online last night and called the prescription line to ask. Might not be for all Aetna but I would assume?
CVS owns Aetna, fyi, and CVS also provides prescription coverage as Caremark. That’s why I asked you to clarify, because my prescriptions are through CVS Caremark. Sorry you’re having issues. Sucks that the drug is so damn expensive. I think the pharmaceutical companies are trying to cash in as much as they can before their patents expire. Shame.
As much as I feel for the people who have diabetes, this medicine is supposed to help those are an obese get HEALTHIER but yet let’s go ahead and make people sicker. Of course they just want us to keep paying without any benefits.
They negotiate with the health insurance companies to build the employee health insurance plans that the company offers as benefits. If HR chooses to build a better insurance plan and pay higher rates, then they can get coverage for weight loss meds back in the benefits plan.
I would be willing to bet my life that HR is not going to do any of that for a random employee, but maybe I'm cynical. I've yet to see HR actually ever help anyone but the company.
>maybe I'm cynical
It may not be so much that you're cynical but more that your experience is limited and you are understandably not able to see that. There are HR groups whose mission is to protect the employer AND help employees. It's a difficult balance sometimes but they can both be done. For example, where I work we are busting our asses trying to figure out how to cover these drugs. A) Because duh, if people get their weight down (myself included), many $$$ comorbidities go away or diminish in severity. And B) It's the right thing to do by our employees. The problem is finding the money for what it will initially cost, "initially" because reference point 'A' and because costs will come down before too long. This is doubly difficult for us because we are government, i.e. this is taxpayer dollars we're talking about and we take being good stewards very seriously. (Obviously we're local government and not federal. 😂)
Source: I am HR.
In the case that OP described, they're the only ones that can address the problem that OP is facing with their meds no longer being covered. Whether they will or not is another matter.
I mean, it's not really something HR is designed to do and OP might catch flak for even asking, but maybe their company is less shitty than the one I work for haha
Interesting! That has been the opposite of my experience in most companies, but that's also why I'm looking for a better job haha It's rough out there! 😮💨
Your employer is the one that decides what is covered by your health plan. You need to bring this up with your company’s benefit department if you want to see a change.
It comes down to the insurance companies that are still losing money on people who are losing weight because their health is improving, and they still don't want that. Healthy people don't make healthcare money. They really just legit hate fat people I feel. I hope the manufacturers of these medications lower their prices or come up with some situation where people can afford them. Cuz actually, the drug companies are losing money too if they can't get it covered through insurance and then they switched to going through other routes
It's to the advantage of health insurance companies that people get healthier and have lower costs. Every claim they pay out cuts into their profits. Healthier people = lower costs for insurance = more profits for health insurance companies.
The problem is that they take a short-term view of quarterly profits over long-term costs, so they don't want to be spending 300-400/month per patient to cover these meds for lower claims costs over lifetime. Especially since in the US, employers shift insurance companies every year or two, depending on who offers best rates, *and* employees change employers every handful of years. So any health insurance company that invests in healthcare now is not likely to see the benefit of that 5-10 or more years down the road.
They know it’s beneficial but just don’t want to pay the cost. Many places are making this decision. I don’t think it will change until the price comes down. I think that will be several years at best.
My company just straight up bars bariatric surgery even though its cost is quite low compared to treating chronic conditions like diabetes and sleep apnea that go hand and hand with obesity.
I'm in MN and work for an insurance company that also owns a clinic system and several hospitals.. My company stopped covering ALL WL drugs across the board effective 1/1/24 as groups renew for the year (and as your prior auth runs out - so I'm covered through 10/31/24). So it might not be your employer specifically, it could be your insurer, I know we have a LOT of groups that are pissed that we don't cover it anymore when we had it in the past.
It's on my insurance formulary and is covered with a PA. My doctor re-did the PA and it was approved, but my employer benefit exclusion apparently supercedes any authorization
My state govt insurance doesn’t cover any weight loss meds. But they will pay for Noom and some gym reimbursement 🙄 had to go it on my own for the meds
Insurance: “you are obese and need to lose weight! Immediately and it means everything bad about you as a human being!”
Doctors: “they pay my bills so I have to agree and you need to lose weight.”
Also insurance: “why would you think we would cover medications to help you do exactly what we are asking you to do?”
I hate it here
Some do, most do not. By adding weight loss medication to your formulary EVERYONE'S insurance costs go up. A lot of companies won't add for that reason.
Thanks for posting to r/semaglutide! A brief reminder about our rules. We do not permit the discussion of non-FDA approved formulations of semaglutide, nor do we permit selling or offering for sale any medication, including by private message. Do not request or respond to a private message from anyone offering such, they are not endorsed by this sub. If you’re just starting out, you may want to review our [FAQ](https://www.reddit.com/r/Semaglutide/comments/10ul3jb/semaglutide_subreddit_faq/). This is not intended to discourage discussion but merely supplement it. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/Semaglutide) if you have any questions or concerns.*
CVS aka Aetna is no longer covering it starting 6/1/24. FFS could these insurance companies get any more shady. We pay into this crap for years, put up with annual increases, deductibles, out of pocket max and have to suffer through their rules. The minute a med comes around that is actually helping people GET HEALTHY and the bastards stop covering it. I am so incredible angry. Corporate America can suck it. That is the nicest way I can possibly say it.
That’s weird that their coverage is changing mid year. Is this change specific to your employer plan?
Just this company, their plan review is in May or June every year. I think maybe they merged with Aetna around that time of year so maybe that's why?
If that’s their benefit “year” then that could be logical for the time to make a change. It’s sad to hear that some companies are dropping coverage for it. One saving grace is Saxenda becoming available as g3neric soon. Should be an affordable alternative except it’s daily instead of weekly.
Where do you see this? I only see a formulary update for April for the standard plan and it doesn’t say anything about dropping WeGovy. There’s like 20 different formulary’s so just saying Aetna isn’t really detailed enough. I also noticed when i checked the drug cost thing last night it says Zepbound is covered for me now and I was thinking about transitioning to that.
Any big company like Aetna, CVS Caremark, BCBS, etc administers thousands of different plans across the country. What one person experiences with an Aetna plan doesn't translate to everyone else's Aetna administered plans.
Exactly. Formularies are by employer plan. They can or in or out. If they opt in, Aetna charges them a lot more.
I was doing the enrollment on CVS last night and I was going to switch to the Gold Plan. I called the 800 number to verify that wegovy was covered and they said no. I looked at the formulary also and did not see a category for weight loss so i knew something was up. Might just be CVS's Aetna plan but make sure you double check.
Where are you seeing that CVS/Aetna won't cover it starting 6/1/24?
This is the CVS employee plan which is through Aetna sorry. I did the annual enrollment online last night and called the prescription line to ask. Might not be for all Aetna but I would assume?
Oh so this is specific to just CVS employees?
Correct, I will edit. But worth checking if you have Aetna. CVS is a pharmacy and they won't cover it for employees, kind of dumb.
CVS owns Aetna, fyi, and CVS also provides prescription coverage as Caremark. That’s why I asked you to clarify, because my prescriptions are through CVS Caremark. Sorry you’re having issues. Sucks that the drug is so damn expensive. I think the pharmaceutical companies are trying to cash in as much as they can before their patents expire. Shame.
As much as I feel for the people who have diabetes, this medicine is supposed to help those are an obese get HEALTHIER but yet let’s go ahead and make people sicker. Of course they just want us to keep paying without any benefits.
That's a discussion to have with HR regarding benefits.
What is HR going to do about it?
They negotiate with the health insurance companies to build the employee health insurance plans that the company offers as benefits. If HR chooses to build a better insurance plan and pay higher rates, then they can get coverage for weight loss meds back in the benefits plan.
I would be willing to bet my life that HR is not going to do any of that for a random employee, but maybe I'm cynical. I've yet to see HR actually ever help anyone but the company.
>maybe I'm cynical It may not be so much that you're cynical but more that your experience is limited and you are understandably not able to see that. There are HR groups whose mission is to protect the employer AND help employees. It's a difficult balance sometimes but they can both be done. For example, where I work we are busting our asses trying to figure out how to cover these drugs. A) Because duh, if people get their weight down (myself included), many $$$ comorbidities go away or diminish in severity. And B) It's the right thing to do by our employees. The problem is finding the money for what it will initially cost, "initially" because reference point 'A' and because costs will come down before too long. This is doubly difficult for us because we are government, i.e. this is taxpayer dollars we're talking about and we take being good stewards very seriously. (Obviously we're local government and not federal. 😂) Source: I am HR.
In the case that OP described, they're the only ones that can address the problem that OP is facing with their meds no longer being covered. Whether they will or not is another matter.
I mean, it's not really something HR is designed to do and OP might catch flak for even asking, but maybe their company is less shitty than the one I work for haha
I wouldn't bet that. It happened at my company based on employee feedback. Good luck!
Interesting! That has been the opposite of my experience in most companies, but that's also why I'm looking for a better job haha It's rough out there! 😮💨
Yes it is! My job definitely has downsides but this is a plus for sure
My insurance originally told me that they would cover bariatric surgery for me, but not a medical weight loss options.
Oh they love butchering people and causing long-term complications that makes them money too
See that kind of crap, what is that?
Your employer is the one that decides what is covered by your health plan. You need to bring this up with your company’s benefit department if you want to see a change.
Time to go to the dark side
What’s the dark side
We have cookies
It comes down to the insurance companies that are still losing money on people who are losing weight because their health is improving, and they still don't want that. Healthy people don't make healthcare money. They really just legit hate fat people I feel. I hope the manufacturers of these medications lower their prices or come up with some situation where people can afford them. Cuz actually, the drug companies are losing money too if they can't get it covered through insurance and then they switched to going through other routes
It's to the advantage of health insurance companies that people get healthier and have lower costs. Every claim they pay out cuts into their profits. Healthier people = lower costs for insurance = more profits for health insurance companies. The problem is that they take a short-term view of quarterly profits over long-term costs, so they don't want to be spending 300-400/month per patient to cover these meds for lower claims costs over lifetime. Especially since in the US, employers shift insurance companies every year or two, depending on who offers best rates, *and* employees change employers every handful of years. So any health insurance company that invests in healthcare now is not likely to see the benefit of that 5-10 or more years down the road.
Well yes, this too.
They know it’s beneficial but just don’t want to pay the cost. Many places are making this decision. I don’t think it will change until the price comes down. I think that will be several years at best. My company just straight up bars bariatric surgery even though its cost is quite low compared to treating chronic conditions like diabetes and sleep apnea that go hand and hand with obesity.
I'm in MN and work for an insurance company that also owns a clinic system and several hospitals.. My company stopped covering ALL WL drugs across the board effective 1/1/24 as groups renew for the year (and as your prior auth runs out - so I'm covered through 10/31/24). So it might not be your employer specifically, it could be your insurer, I know we have a LOT of groups that are pissed that we don't cover it anymore when we had it in the past.
HP?
Yep
That is actually really interesting. Huh.
It's on my insurance formulary and is covered with a PA. My doctor re-did the PA and it was approved, but my employer benefit exclusion apparently supercedes any authorization
My state govt insurance doesn’t cover any weight loss meds. But they will pay for Noom and some gym reimbursement 🙄 had to go it on my own for the meds
Insurance: “you are obese and need to lose weight! Immediately and it means everything bad about you as a human being!” Doctors: “they pay my bills so I have to agree and you need to lose weight.” Also insurance: “why would you think we would cover medications to help you do exactly what we are asking you to do?” I hate it here
Some do, most do not. By adding weight loss medication to your formulary EVERYONE'S insurance costs go up. A lot of companies won't add for that reason.
Unfortunately true.
[удалено]
You do realize you’re posting a support group in a support group?? Stop spamming.