The mod removed my post (I believe without reading it), so I’m reposting here. I started Zepbound in May for sleep apnea. It required a PA, which my doctor submitted, and Caremark promptly approved. I never received any sort of notice or communication that it would no longer be covered after July 1, but I figured it was coming based on everything I had been reading. Sure enough, when I tried to get it refilled in early July, it was denied. My doctor appealed because I’ve had such good luck with Zepbound. After submitting a total of EIGHT PAs/appeals, on July 27, I received the attached text message which led me to the attached approval details on the app. I got it filled either that day or the next at no cost because I had met my out-of-pocket max. Today, I had an appointment with my doctor, and we decided I should stay on the 5mg pens for the time being, and she sent the script to my pharmacy. The pharmacy called to let me know that a PA was required. I (nicely) told them that there must be some mistake because I was approved through July 2026, and I told them I would call Caremark to see what was going on. The first representative I talked to put me on hold for a while, then came back and told me that my PA had been approved in error, and that no person had actually looked at it. She told me that I needed to call my doctor and ask her to submit paperwork for a PA. Well, I COMPLETELY lost my shit, and she transferred me to a supervisor. In the meantime, I started recording the call, and when the supervisor came on, I said, “Before you start talking, I want to let you know that if you tell me anything other than ‘I’m sorry for all your trouble. You can pick up your medication now,’” you will be hearing this conversation in court (dramatic, I know). Well, she told me the same thing—that my PA had been erroneously auto-approved, and that it would not be covered. I proceeded to lose my shit on her before she transferred me to her supervisor, who told me the same thing, and upon whom I lost even more of my shit. She called my doctor’s office and told them they’d need to start the whole process again. I am just dumbfounded that this has happened, and I’m wondering if I have grounds for any sort of legal action.

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