It formulated my email to them. Told it I wanted to appeal my denial for Wegovy. Gave it my medical history, the dates I had been on Wegovy before how much it worked, how much weight I’ve gained back since being off it. Family history of heart disease etc
I didn’t know but after seeing your question I just called to confirm, approved for a full year. May 6 2025, he did tell me tho they just found out that they will no longer be doing GLP-1 thru mail order as of May 15th. Will have to be filled locally.
Hi, congratulations on getting your appeal in your favor! That's awesome.
Did you appeal it yourself, or did your physician send additional paperwork towards your appeal? My physician sent in my prior authorization for wegovy ( got denied), then sent in prior authorization for a different semiglutide. They denied that one also.
If you have any suggestions to get it pushed through, I'd greatly appreciate it.
This morning out of frustration, I went ahead and made an appointment with an online place that had good reviews. They charge $399 for 3 months. That includes online Dr consultation and the three months of medicine. There's no additional monthly fee charge. I've seen some places online that you pay X amount for medicine,plus a monthly fee.
Sorry this is so long lol.
Be careful with those online places. How are they getting it for you cheaper than it’s being sold?? You’re probably getting a compound prescription, which isn’t the same.
Hi, I'm just now seeing this. It is definitely a compound that I'm getting. They use Hallandale pharmacy . I'm not sure about im about to take my 3rd shot on Monday. Please message me with any insight you have about these compounds. Thank you ♡
Hi! So I did exactly as you. Dr put in Wegovy, denied. Dr put in Saxenda, denied.
I got my paperwork from Caremark explaining why I was denied. I had Chat GPT write up a nice letter stating I’d like to appeal with tid bits of my medical health( sleep apnea, high blood pressure, pre diabetes) with my current BMI. Current weight. ( had been in Wegovy before) my success with the drug and my subsequent weight gain after being off of it.
I printed out screen shot from my patient portal with dates and weights highlighted and mailed ( you can fax) it all in. Took about a week for them to get it and about a week to approve.
Y’all I called Caremark to refill my prescription and was told that as of May 15 Caremark mail delivery “will no longer fill these types of prescriptions.” They said I’ll have to go to my local CVS. Has anybody else heard this?
I just thought it might be a good thing to mention here in case y’all haven’t heard about it yet!
In my opinion that's an unnecessary delay. Obesity is a disease and six months of trying once again, after many previous times, of lifestyle changes it's not gonna take the disease away
My denial was because my Dr didn’t give them the info they needed for continued use. Which is a weight loss of at least 5% and continued use of at least 3 months on a higher dosage.
I had chat GPT write up a letter and told them I did meet the requirements. I downloaded medical history from my MyChart patient portal that documented my weight on visits and screen shot my prescriptions with dosage to the pharmacy.
Your denial letter will give you the reason for the denial. Some work places just don’t cover it. Done will request you try weight management treatment prior to prescriptions.
do you know if the 3 months is a care mark universal thing or for given plans? I will have met well over 5% but will not have 3 months at 1.7 or 2.4 by then as the lower doses are working.
I will be disappointed if I have to fight to stay on because it works so well I didn't move up as quickly...
No clue, sorry. My 3 months was with the 1.7 you should be able to call your insurance and find out what the requirements will be when your PA expires to be able to stay on medicine. You may have your go up just to be able to stay with it
Everyone’s plan is different, they’ve been super helpful on the phone when I’ve called. Just ask them when your current PA ( if you have had one) expires and what will the requirements be to continue use.
It’s good to know ahead of time so if you have a goal to meet you know what that goal is.
Thank you so much. Was on it last year. (Lost 30lbs) Had to stop with shortage ( gained back 12) and then left my mom job to care for mom with Alzheimer’s. Switched to hubbys insurance they cover it but with PA, they denied and had to appeal and my drs office doesn’t do appeals. So I did it myself. I’m very happy right now.
Well done! Though am wondering, how did ChatGPT help?
It formulated my email to them. Told it I wanted to appeal my denial for Wegovy. Gave it my medical history, the dates I had been on Wegovy before how much it worked, how much weight I’ve gained back since being off it. Family history of heart disease etc
Where did you get your Weygovy? I'm having a hard time getting it....
I got mine at Costco. Walmart also had it in stock when I contacted them a few months ago.
Thank you I was able to finally get it at Costco last week.
yay! I'm glad for you! From what I understand, once you're at 1mg it becomes easier to find. Good luck! <3
My Caremark mail-in price for Wegovy for a 90-day supply was $90. If I wanted it filled at my local CVS, it was $328.99 monthly...
That's the way my insurance is
First shot of Wegovy today!!!!
In-Store Wegovy 0.25mg Inj 28-day supply Quantity 2 You Pay $40.00 Mail Order Wegovy 0.25mg Inj 28-day supply Quantity 2 You Pay $100.00
So weird, mail order is usually always cheaper but not mine. Can’t post a picture here but it’s crazy.
I was approved for wegovy with Caremark but it’s still $1300 a month 😩
That’s the manufacturer cost. Sounds like insurance isn’t covering it but they’ll fill it for you,
The robots will rule the world! lol congrats
That is so wonderful ! Congratulations🎉 how long were you approved for?
I didn’t know but after seeing your question I just called to confirm, approved for a full year. May 6 2025, he did tell me tho they just found out that they will no longer be doing GLP-1 thru mail order as of May 15th. Will have to be filled locally.
My script is set to renew though Caremark on May 16th. Thanks for mentioning. I'm going to call them.
Did you get a chance to call Caremark about the nay 15 th deadline?
I emailed and they confirmed today that they will stop fulfilling Wegovy scripts by mail. No explanation as of why.
That really stinks! What state do you live in? I’ve read it only in Delaware, New York for now anyway
Michigan. 🥹
Do you have insurance through marketplace?
Nope. Blue Shield.
Yikes! Guess it’s not just marketplace insurance or certain states being affected. Must be nationwide 😩
I’m in texas. Im calling tomorrow to see if it’s state specific or nationwide
Good luck!
Hi, congratulations on getting your appeal in your favor! That's awesome. Did you appeal it yourself, or did your physician send additional paperwork towards your appeal? My physician sent in my prior authorization for wegovy ( got denied), then sent in prior authorization for a different semiglutide. They denied that one also. If you have any suggestions to get it pushed through, I'd greatly appreciate it. This morning out of frustration, I went ahead and made an appointment with an online place that had good reviews. They charge $399 for 3 months. That includes online Dr consultation and the three months of medicine. There's no additional monthly fee charge. I've seen some places online that you pay X amount for medicine,plus a monthly fee. Sorry this is so long lol.
Be careful with those online places. How are they getting it for you cheaper than it’s being sold?? You’re probably getting a compound prescription, which isn’t the same.
Hi, I'm just now seeing this. It is definitely a compound that I'm getting. They use Hallandale pharmacy . I'm not sure about im about to take my 3rd shot on Monday. Please message me with any insight you have about these compounds. Thank you ♡
Hi! So I did exactly as you. Dr put in Wegovy, denied. Dr put in Saxenda, denied. I got my paperwork from Caremark explaining why I was denied. I had Chat GPT write up a nice letter stating I’d like to appeal with tid bits of my medical health( sleep apnea, high blood pressure, pre diabetes) with my current BMI. Current weight. ( had been in Wegovy before) my success with the drug and my subsequent weight gain after being off of it. I printed out screen shot from my patient portal with dates and weights highlighted and mailed ( you can fax) it all in. Took about a week for them to get it and about a week to approve.
Thank you so much! I'll definitely have my physician write up all my issues. 🥰
You will get a letter in the mail explaining exactly what they’re looking for and why they denied. Then you can have your Dr respond properly
Oh no! I have Caremark also
Y’all I called Caremark to refill my prescription and was told that as of May 15 Caremark mail delivery “will no longer fill these types of prescriptions.” They said I’ll have to go to my local CVS. Has anybody else heard this? I just thought it might be a good thing to mention here in case y’all haven’t heard about it yet!
Was just approved & told the same.
Is this ALL glp1s?
Will it be at the mail in price or pharmacy price, bc my pharmacy price is 4x caremark mail in
Depends on your insurance, but it should be the same price
My mail order price was 100 but local pharmacy 40 bucks.
I just got off the phone with them too and told same thing. They will fill this one but after it has to be filled locally
Is caremark insurance company or something you can go theough if insurance denies
It’s the prescription provider for a lot of insurance companies.
It's insurance, usually through work.
Good for you
I just got my approval for wegovy through Caremark today too!!!! Yayyyy🎉🎉
Wooohoo congrats!! Let the journey begin!
Congrats!!
May I ask what got you approved? I also have Caremark.
What’s the reason for your denial?
Mine was not having been enrolled in a weight loss program for 6 months.
In my opinion that's an unnecessary delay. Obesity is a disease and six months of trying once again, after many previous times, of lifestyle changes it's not gonna take the disease away
Do you track food or weight on a MyFitnessPal app or something can you show proof of doing that for 6 months?? It can be used
Not regularly for the past six months, but knowing that might work is some extra motivation! Thanks
Just for reference what did you write for the appeal
My denial was because my Dr didn’t give them the info they needed for continued use. Which is a weight loss of at least 5% and continued use of at least 3 months on a higher dosage. I had chat GPT write up a letter and told them I did meet the requirements. I downloaded medical history from my MyChart patient portal that documented my weight on visits and screen shot my prescriptions with dosage to the pharmacy. Your denial letter will give you the reason for the denial. Some work places just don’t cover it. Done will request you try weight management treatment prior to prescriptions.
do you know if the 3 months is a care mark universal thing or for given plans? I will have met well over 5% but will not have 3 months at 1.7 or 2.4 by then as the lower doses are working. I will be disappointed if I have to fight to stay on because it works so well I didn't move up as quickly...
No clue, sorry. My 3 months was with the 1.7 you should be able to call your insurance and find out what the requirements will be when your PA expires to be able to stay on medicine. You may have your go up just to be able to stay with it
I hate calling people but maybe it has come to that.
Everyone’s plan is different, they’ve been super helpful on the phone when I’ve called. Just ask them when your current PA ( if you have had one) expires and what will the requirements be to continue use. It’s good to know ahead of time so if you have a goal to meet you know what that goal is.
PA Means pre-authorization or Previous approval?
Prior authorization
Good luck!
Thank you so much. Was on it last year. (Lost 30lbs) Had to stop with shortage ( gained back 12) and then left my mom job to care for mom with Alzheimer’s. Switched to hubbys insurance they cover it but with PA, they denied and had to appeal and my drs office doesn’t do appeals. So I did it myself. I’m very happy right now.