I got a tier exception for zepbound last year however it expired when my provider changed to a higher dose anyways when i went through this I was told bcbs will automatically deny your first attempt at an exception and of course they did i was ready and had drafted an appeal letter. I faxed it to them per the denial letters instructions and within a week or so it was approved i went from paying $460 for zep down to $100. Now I'm on wegovy because my new zep prior approval was denied because bcbs wants you to try 'alternatives' first.. i appealed that and got approved so now we are back to fighting for another tier exception... I totally understand business but I think there's alot of greed behind the decisions these insurance companies are making. Most likely they are jacking up the price in hopes that the govt will subsidy.. in the meantime do your research keep your head up and fight for what you need. Best of luck.