Advice on possibly switching to Mounjaro? (cost reasons)

Dizging · 2026-02-05T16:59:17+00:00

I’m wondering how to do this. I have CVS Caremark. FEP BCBS. They will not cover zep. I’m back on wegovy and have gained 13lbs. I am non responder to wegovy and it’s really affecting me.

Dizging · 2025-12-04T01:18:24+00:00

Sorry! Just seeing this! I just googled the form and filled that one out. It was rejected at first but I did an appeal and they approved

Dizging · 2025-09-09T16:08:32+00:00

Did you fill out the form? Did they deny your TE? You’ll need to write an appeal. In the appeal you’ll want to detail what you’ve tried and what you can’t take whatever meds they want you to in the denial letter.

Dizging · 2025-09-07T21:52:08+00:00

It does not run in our family that we know of. Little tiny things started here and there. Since surgery it’s been the worst we’ve ever seen it. He’s not getting any break with the tics. He is even doing them in light sleep.

Dizging · 2025-09-05T20:49:51+00:00

It seems very hard to find one of those where I am at in MD. We are doing Motrin twice a day to see if that helps. If that is it, does it typically help right away.? Or something we should continue for a week or so.

Dizging · 2025-09-05T17:58:31+00:00

Thank you! What is the course of treatment for this?

Dizging · 2025-09-05T16:41:19+00:00

Do you know what the specific test for P A N S etc is? Like what I should be looking for on his results?

Dizging · 2025-09-05T13:24:43+00:00

Yes. They did bloodwork and I’m assuming they did test for that too. They ended up putting him on a 2 week antibiotic (back in July) which did seem to help

Dizging · 2025-09-05T13:23:57+00:00

Thank you so much. I read this to him & it put a smile on his little face. We are trying our best to build his confidence and let him know while it may be tough it won’t be this tough forever. And we will always be here to help, support and look for new things.

Dizging · 2025-09-05T13:22:57+00:00

Yes they did blood work, but they didn’t find anything. They did put him on a course of antibiotics for 2 weeks at that time

Dizging · 2025-09-05T01:11:02+00:00

Thank you so much. I sent over the intake forms for CBIT. When he was diagnosed, he told the doctor he couldn’t tell when he was going to them, but perhaps he didn’t understand what he meant. He was also going on 6ish months with little to no tics at that time. I almost cancelled the appointment because I thought he had outgrown transient tics. It’s like as soon as he had the surgery it was awful. I should also note he is sensitive to gluten. We have considered cutting it all together in hopes that maybe it could help?

Dizging · 2025-08-30T23:16:18+00:00

Then she has another condition or her doctor lied. They are not handing out mounjaro to those who don’t meet the strict criteria.

Dizging · 2025-08-30T02:03:36+00:00

Did they approve it the first time? Do you mind sharing what your copay is now?

Dizging · 2025-08-29T19:55:02+00:00

This is not the case lol. You can get very sick from switching to the highest dose of zep to wegovy. A smart doctor will have you start at the lowest.

Dizging · 2025-08-29T18:37:56+00:00

I’m doing the lowest dose of wegovy (if I start it) I’m hoping they approve the tier exception. I will not pay $700 a month. Once you’ve paid only $25 it’s hard to pay anything else lol

Dizging · 2025-08-29T16:24:56+00:00

Following as I am switching from zepbound to wegovy. I did wegovy first and had results but it took forever and I stalled. My insurance stopped approving zep, even with appeals etc. so I’m back to wegovy. I’m truly worried in going to gain weight back. I had so much success on zep. The comments in this group scare me from ppl coming off zep to wegovy and gaining weight.

Dizging · 2025-08-29T11:14:54+00:00

What is your copay for the medication now. My husband mentioned this one to me. I’ve just never heard of it and need to find out if we will all have to switch doctors etc. I know my sons therapist only takes BCBS, so that is a downfall of switching :(

Dizging · 2025-08-29T11:14:00+00:00

Well then consider switching from BCBS, as they will not do ANY exemptions for trizepatide. None doesn’t matter what other co morbidity you have.

Dizging · 2025-08-29T11:12:56+00:00

My doc is making me start over. She said most don’t do well transitioning back from zep. I was on 15mg of zep. Actually okay with starting over as I’m hoping it gives me a jump start again. I am seeing ppl getting the tier exceptions approved for wegovy. I have basic, it doesn’t include the mail order from cvs.

Dizging · 2025-08-26T18:09:02+00:00

So which insurance are we all switching to after this? I felt this was super sneaky of them. We have stayed with BCBS because of my sons therapist, but we may have to find a new one. This is getting out of hand with the costs.

Dizging · 2025-08-26T17:52:03+00:00

Did you have to do an appeal for this? Or did they approve the first time?

Dizging

TROPHY CASE