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re: How to get husband’s generic mounjaro script filled? Compound formula not legal in LA

Posted on 2/15/24 at 10:10 pm to
Posted by starlight
A beach somewhere in the Caribbean
Member since Oct 2008
2037 posts
Posted on 2/15/24 at 10:10 pm to
Blue cross isn’t going to cover it for anything but type 2 diabetes. If he isn’t type 2 give it up. I recently was prescribed the same meds because of insulin resistance. Even though that eventually leads to type 2 they won’t cover it. I diet and lose 20lbs then stop losing. Doesn’t matter what diet and exercise I try. My doctor said that is typical of insulin resistance. The manufacturer coupon only works if you are diagnosed as type 2. If you lie to get it they look at the diagnosis and still deny paying. Technically there is not a generic of mounjaro approved by the fda yet. There is a compounding pharmacy my doctor likes/trusts so he called in my script there. It’s still stupid expensive. If your doctor is telling you to go the compounding route they should call in a prescription to the compounding pharmacy. That is what mine did. I have a friend that works for blue cross and she told me other states blue crosses have approved the medicine for insulin resistance but ours will not. Today I emailed Senator Kennedy and Cassidy and representative Graves along with the insurance commissioner of Louisiana. It makes no sense that you wouldn’t attempt to prevent a disease but wait to treat until it’s a full blown issue, or pay for bariatric surgery which is way more expensive. And how is it ok that medications your doctor prescribes would cost $1200 a month (what I was told by my pharmacy) without insurance. I’m sure local representatives and senators would be a good route to go but both of mine are new so I don’t know how much pull they have and one I don’t trust to even read the email. That is a very non helpful answer but this is my experience dealing with similar issues.
Posted by Uncle JackD
Member since Nov 2007
58671 posts
Posted on 2/16/24 at 5:57 am to
quote:

Blue cross isn’t going to cover it for anything but type 2 diabetes. If he isn’t type 2 give it up
This is bullshite. Every single plan is different, it’s completely up to your employer. Not t2D here and I’ve had tirz (mounjaro and now Zepbound) covered by insurance since march 23’.

It’s always worth a shot. The answers always no if you don’t ask.

Star, if you’re willing to go and trust the peptide route, there’s VERY affordable options out there.
This post was edited on 2/16/24 at 6:00 am
Posted by lsu777
Lake Charles
Member since Jan 2004
31617 posts
Posted on 2/16/24 at 8:07 am to
quote:

Blue cross isn’t going to cover it for anything but type 2 diabetes. If he isn’t type 2 give it up. I recently was prescribed the same meds because of insulin resistance. Even though that eventually leads to type 2 they won’t cover it. I diet and lose 20lbs then stop losing. Doesn’t matter what diet and exercise I try. My doctor said that is typical of insulin resistance. The manufacturer coupon only works if you are diagnosed as type 2. If you lie to get it they look at the diagnosis and still deny paying. Technically there is not a generic of mounjaro approved by the fda yet. There is a compounding pharmacy my doctor likes/trusts so he called in my script there. It’s still stupid expensive. If your doctor is telling you to go the compounding route they should call in a prescription to the compounding pharmacy. That is what mine did. I have a friend that works for blue cross and she told me other states blue crosses have approved the medicine for insulin resistance but ours will not. Today I emailed Senator Kennedy and Cassidy and representative Graves along with the insurance commissioner of Louisiana. It makes no sense that you wouldn’t attempt to prevent a disease but wait to treat until it’s a full blown issue, or pay for bariatric surgery which is way more expensive. And how is it ok that medications your doctor prescribes would cost $1200 a month (what I was told by my pharmacy) without insurance. I’m sure local representatives and senators would be a good route to go but both of mine are new so I don’t know how much pull they have and one I don’t trust to even read the email. That is a very non helpful answer but this is my experience dealing with similar issues.



mine covers it. i dont take it but BCBS does cover it depending on plan.


ETA: forgot my scripts are through cvs caremark, so dunno if bcbs covers it, my bad
This post was edited on 2/16/24 at 8:08 am
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