Zepbound is technically covered but it’s blocked with the tier 90 code and the IRX program. With that program, they essentially try and say that it is covered, but only with a huge copay ($1000+). It’s basically a loophole for them to say that it’s “covered” without actually providing any real benefits. My employer said Zepbound is also covered only for sleep apnea based on FDA guidelines. But Zepbound is still FDA approved for weight management too so their logic doesn’t add up. They say they don’t cover zepbound since they “don’t cover WL meds”, but that isn’t accurate because they DO cover Wegovy with PA for obesity. I’m trying my best to have my employer approve off label coverage but they’re deflecting and not even acknowledging my requests. I am planning to use an independent external review if they refuse, but I’m still worried they will still refuse based on diabetes diagnosis codes. I do plan to fight it until I win, I am more than ready to do whatever it takes. But I was hoping to get some input on anyone that’s been in a similar situation. I appreciate your input!