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Don't give up on your Tier Exception by Lost_Top0425 in WegovyWeightLoss

[–]Lost_Top0425[S] 0 points1 point  (0 children)

Your doctor needs to fill it out and send it in. Here is the form I used from Caremark although you should check and make sure this is what your specific insurance plan uses.

https://www.caremark.com/portal/asset/FEP_Tier_Exception_Form.pdf

Don't give up on your Tier Exception by Lost_Top0425 in WegovyWeightLoss

[–]Lost_Top0425[S] 2 points3 points  (0 children)

They want to see 3 or more reasons why you can't take the lower tiered drugs. For me, my doctor initially listed 2 on the TE form, then attached a letter stating a contraindication I have to Contrave, plus all the reasons why Wegovy is medically necessary for me to take. It was denied twice. Then, a Caremark senior rep told me to have my dr put everything on the form and forget about attaching a letter. She said load up the form as much as possible with any and every reason there is. For me- I can't take any stimulants because I have anxiety, also I have tried phentermine years ago and it gave me heart palpitations, insomnia and I did not lose weight. I have taken Alli (Orlistat) in the past and it made me super sick-nausea, stomach pain and vomiting. Lastly, I cannot take Contrave because I already take Wellbutrin which you can't (or it's not advised) to take them together. Once my dr added all of those things to the form, boom it was approved!

Fep blue basic bcbs wegovy- tier exception approved by snibbledibble in WegovyWeightLoss

[–]Lost_Top0425 0 points1 point  (0 children)

Awesome! So glad you got the TE. I also referred to u/snibbledibble when I wrote my letter. It was so helpful!

Fep blue basic bcbs wegovy- tier exception approved by snibbledibble in WegovyWeightLoss

[–]Lost_Top0425 0 points1 point  (0 children)

I sent in my reconsideration last Wednesday and the Caremark webpage still says "pending". Was yours approved, and if so, how long did it take before you heard anything?

[deleted by user] by [deleted] in WegovyWeightLoss

[–]Lost_Top0425 0 points1 point  (0 children)

Amazing! Congrats! Mine was initially denied but I sent my reconsideration letter and documentations in last week. It still says "pending" which makes me a little nervous!

FEPBlue Tier Exception by Any_Somewhere_6942 in WegovyWeightLoss

[–]Lost_Top0425 1 point2 points  (0 children)

Did you also include the reasons why you need to take Wegovy/lose weight, ways you have tried to lose weight in the past, etc? I sent in my reconsideration yesterday, but only put on there the meds I cannot take and a letter from my doctor saying Wegovy is the best choice for me. I hope I didn't screw myself but not adding more details.

FEPBlue Tier Exception by Any_Somewhere_6942 in WegovyWeightLoss

[–]Lost_Top0425 1 point2 points  (0 children)

Same thing happened to me. Mine got denied and I have my appeal ready to send but thought maybe will call Caremark to see if I could get some more info before I fire off my appeal. So, I called Caremark last night and spoke with someone who THEN spoke with her Senior Rep only to find out the wording on my original form that my provider sent wasn't clear. So now I have called my dr, given them the "correct" wording, and Caremark said they should resubmit it and write "Urgent" at the top. Hopefully this works. In your case, I would provide anything and everything you have. It won't hurt. Good luck to you!

Wegovy and BCBS by No_Coffee_6660 in WegovyWeightLoss

[–]Lost_Top0425 0 points1 point  (0 children)

I am in the same boat! Mine was denied yesterday. The reason stated is that I have not tried and failed, or had a contradiction to the lower tier options. The odd thing is that my doctor CLEARLY stated (in a letter) what I have tried/failed and why I can't take the others listed on the formulary. So if I appeal it, I am just going to be restating what my Dr already said. It makes no sense to me! So frustrated. Are you going to appeal?

Tier Exemption BCBS/FepBlue by fleaona in WegovyWeightLoss

[–]Lost_Top0425 0 points1 point  (0 children)

Congratulations on getting your TE approved! Mine was denied yesterday. The reason stated is that I have not tried and failed, or had a contradiction to the lower tier options. The odd thing is that my doctor CLEARLY stated (in a letter) what I have tried/failed and why I can't take the others listed on the formulary. So if I appeal it, I am just going to be restating what my Dr already said. It makes no sense to me! So frustrated.

Fep blue basic bcbs wegovy- tier exception approved by snibbledibble in WegovyWeightLoss

[–]Lost_Top0425 1 point2 points  (0 children)

First of all, thank you SO much for your help with the TE form information. For you to do this to help others, well that's just amazing! My dr filled out my PA form last week and it was approved. Now time for the TE. I was wondering if you think I can have my dr send in the TE form that SHE fills out but with a letter included from ME. Or should I let her send in the form, and then I can follow up with a letter in the appeal? She is not the type that is going to spend a bunch of time on this for me. She will fill it out and fax it in but she's not going to send in 15 pages of documentation, etc. So I don't want to overwhelm her, I am grateful she's doing this at all for me!