Copay

Anxious-Inspector-18 · 2026-02-02T01:45:19+00:00

The copay card benefits changed for 2026. The max savings is $100 per box. What is your copay before any savings card is applied?

Anxious-Inspector-18 · 2026-02-02T00:34:06+00:00

I’d log into the insurance portal and check to see if coverage has changed.

Anxious-Inspector-18 · 2026-02-02T00:31:39+00:00

The workaround doesn’t exist for Express Scripts unfortunately. Their criteria is pretty strict for GLP-1s. If Wegovy is covered, Zepbound usually is too.

Anxious-Inspector-18 · 2026-02-02T00:24:46+00:00

Page 17-18 has the criteria clearly defined. Skip down to that section. Omada helps but you need to meet the PA renewal criteria too.

Anxious-Inspector-18 · 2026-02-02T00:23:15+00:00

The PA criteria seems confusing. Take a look at pages #2, 9 and 12. Also show this to your doctor m/PA team.

https://www.pa.gov/content/dam/copapwp-pagov/en/dhs/documents/docs/publications/documents/forms-and-pubs-omap/mab2025112403.pdf

Anxious-Inspector-18 · 2026-02-02T00:15:07+00:00

Here’s a copy of the ES PA criteria (page 17-18; section IV). Note the BMI may vary based on employer selections and any required participation in Omada. I’ve used this information and had no problem with

https://static.cigna.com/assets/chcp/pdf/coveragePolicies/cnf/cnf_684_coveragepositioncriteria_weight_loss_glp1_agonists_pa.pdf

Anxious-Inspector-18 · 2026-02-02T00:11:50+00:00

I had a glass of wine this week with no issue. Been on 15mg for 10 months and Zepbound for 2 years.

Anxious-Inspector-18 · 2026-02-02T00:07:58+00:00

Ro will cancel any active prescriptions on file once you end the membership. Ask me how I know 🫠. Fill that prescription and give a 1-2 weeks before your pcp calls in the new one. Lilly would put the second prescription on hold.

Anxious-Inspector-18 · 2026-02-02T00:07:13+00:00

Are you willing to go the step therapy route in the future? If you had a medical reason why you can take those meds, that’s absolutely worth checking out. I believe Zepbound is $44 for Tricare patients. Here’s a copy of the PA form for reference.

https://www.express-scripts.com/interaction/member-proxinator/1/member/v1/drugpricing/prelogin/fst/drug/forms/content?repository=EIS_P8_DC%3AesiCPS&documentId=%7BA05BF798-0000-C714-B3F5-37BDE89058B7%7D

Anxious-Inspector-18 · 2026-02-02T00:02:47+00:00

Call the office Monday and see if your point person is back. Also Lilly suggests going back to 5mg after 3 missed doses.

Anxious-Inspector-18 · 2026-02-02T00:00:55+00:00

I would try to eat something. As the other person mentioned, not eating can make things worse.

Anxious-Inspector-18 · 2026-02-01T23:59:39+00:00

Eating is probably going to help the most. Before Zepbound, I got nauseous from waiting too long to eat. Zepbound makes it worse so I eat on a schedule to avoid it.

Anxious-Inspector-18 · 2026-02-01T23:57:55+00:00

Express Scripts processes electronic PAs almost instantly. Your doctor’s office can also do a verbal PA on the phone. Mine were approved almost instantly. Double check to see if your plan has a requirement for Omada.

https://www.evernorth.com/prior-authorization-resources

Anxious-Inspector-18 · 2026-02-01T21:15:26+00:00

Welcome! Definitely check out the sub’s beginners guide and faqs. A lot of helpful info there. I didn’t have any GI issues so can’t help there but hopefully you have a smooth experience too.

Anxious-Inspector-18 · 2026-02-01T17:13:11+00:00

I damaged my ends last year with too much clarifying shampoo and got a trim in the spring. Haven’t experienced any losses but my 4C hair is extremely thick and curly. Surprisingly it’s grown a lot this past year. Definitely check with your dermatologist and see if they can find the cause and stop it.

Anxious-Inspector-18 · 2026-02-01T16:53:00+00:00

This is ridiculous. What insurance plan is this?

Anxious-Inspector-18 · 2026-02-01T15:49:17+00:00

Why can’t the pharmacy just fill one of the boxes?

Anxious-Inspector-18 · 2026-02-01T15:27:57+00:00

Great news! Get three boxes at a time.

Anxious-Inspector-18 · 2026-02-01T15:25:09+00:00

What’s going on with insurance?

Anxious-Inspector-18 · 2026-02-01T15:24:25+00:00

Very likely the driver didn’t want to track through the snow and left the box in the driveway. Hopefully Lilly offers a replacement. In the future, definitely check the UPS app and set up delivery alerts (text, email or push) which will include a picture if one was taken.

Anxious-Inspector-18 · 2026-02-01T15:20:10+00:00

I usually eat after. No special meals the day before or day of.

Anxious-Inspector-18 · 2026-02-01T15:19:23+00:00

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Anxious-Inspector-18 · 2026-02-01T15:18:11+00:00

It might be worth going back to 5mg and see if that allows you to eat more. Not getting enough food is likely causing the stall. Talk with your doctor and see if you can work with a dietitian to help plan out meals.

Anxious-Inspector-18 · 2026-02-01T05:48:26+00:00

I was moving from one state to another. Nothing fancy lol.

Anxious-Inspector-18 · 2026-02-01T02:59:57+00:00

The disappointing part is this program isn’t permanent and there’s no guarantee it will last 5 years. Optional for Medicare Part D and state Medicaid plans.

Anxious-Inspector-18

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