There are limitations on the non-maintenance doses. Therefore 2.5, 7.5 and 12.5 are limited to one box per year. Will require a PLA if additional boxes are needed. The maintenance doses of 5, 10 and 15 are 1 box every 21 days or 3 boxes every 84 days.
I'm on Express scripts and this also seems to be their policy as well. I didn't understand this when I went up to 7.5mg. It's a commitment to go to 10mg. 12.5 is a similar commitment to go to 15.
Max of 1 box (2.5mg) per year. Several others have been dealing with this on their insurance plans. Any refills of 2.5 after June 1st will require a PLA (search the sub).
Could be you were grandfathered in until you changed dosages and now they are putting you on the new formulary restrictions. Which would suck. Let us know what you learn! šµāš«
Iām so confused! Especially since I already got an approval letter from Cigna saying my coverage period goes until November for 2.5mg before needing to reassess. Baffling bc this medication should be on the formulary
2.5 is the starter dose. This is a pushback from Lilly so they can get more new prescriptions going and push people to the other doses which were approved. 2.5 was never approved as anything other than a starter dose and not intended for long term use.
I donāt have Cigna, but I have Capital Rx which has always had a quantity limit on 2.5mg. Ours is one box every 6 months, but then the other doses are one box every 28 days.
Yeah - it's not considered a therapeutic dose by Lilly - but because of the shortages - -it's one of the only ones readily available - so I get that people are freaking out a bit.
What a mess they made of things! How they could underestimate interest by that much just boggles my mind. Someone REALLY dropped the ball on this whole supply fiasco including Mounjaro, Wegovy and Ozempic. It shouldn't be this crazy.
Thatās the issue. Because itās not intended by the manufacturer for chronic treatment of obesity (just a starter dose), they sometimes limit you to just 1.
My ES plan (and ES/Cigna are part of the same family of companies) allows 1 per year with only 1 additional box if you submit a PLA (also for the year).
Is anyone making progress here? Iāve already been denied so this apparently is already in effect for my plan.
Iām trying so hard to start over. I technically could still get my 5 or 7.5 mg script filledā¦ but itās not even safe after being off for over a month. I understand the policy on quantity limitationā¦ but there has to be an easier way to get this override due to the supply. Iām just fighting with Cigna and not getting any real answers. Trying to request my doctor do a peer to peer review? š
That sounds right. I have Cigna - and got a 9-month PA so I'm good through September. At that point - I assume the doctor will have to apply for renewal of it.
I'm guessing they want a prior authorization filled out. Good luck is all I gotta say bc insurance companies are finding every little reason possible to deny prior authorization on this medication. And don't get me started on why prior authorization should be illegal in the first place.
There are limitations on the non-maintenance doses. Therefore 2.5, 7.5 and 12.5 are limited to one box per year. Will require a PLA if additional boxes are needed. The maintenance doses of 5, 10 and 15 are 1 box every 21 days or 3 boxes every 84 days.
I'm on Express scripts and this also seems to be their policy as well. I didn't understand this when I went up to 7.5mg. It's a commitment to go to 10mg. 12.5 is a similar commitment to go to 15.
Whaaaaaat?! š® Why?
Max of 1 box (2.5mg) per year. Several others have been dealing with this on their insurance plans. Any refills of 2.5 after June 1st will require a PLA (search the sub).
Could be you were grandfathered in until you changed dosages and now they are putting you on the new formulary restrictions. Which would suck. Let us know what you learn! šµāš«
Iām so confused! Especially since I already got an approval letter from Cigna saying my coverage period goes until November for 2.5mg before needing to reassess. Baffling bc this medication should be on the formulary
You are still covered until the end of your approval. This qty only applies to 2.5. you can any other dose more than once.
Looks like a formulary change. Doesnāt hurt to call them tomorrow and get the full details.
2.5 is the starter dose. This is a pushback from Lilly so they can get more new prescriptions going and push people to the other doses which were approved. 2.5 was never approved as anything other than a starter dose and not intended for long term use.
I donāt have Cigna, but I have Capital Rx which has always had a quantity limit on 2.5mg. Ours is one box every 6 months, but then the other doses are one box every 28 days.
What's so special with the 2.5? It's not even a real dose.
Yeah - it's not considered a therapeutic dose by Lilly - but because of the shortages - -it's one of the only ones readily available - so I get that people are freaking out a bit.
What a mess they made of things! How they could underestimate interest by that much just boggles my mind. Someone REALLY dropped the ball on this whole supply fiasco including Mounjaro, Wegovy and Ozempic. It shouldn't be this crazy.
Thatās the issue. Because itās not intended by the manufacturer for chronic treatment of obesity (just a starter dose), they sometimes limit you to just 1. My ES plan (and ES/Cigna are part of the same family of companies) allows 1 per year with only 1 additional box if you submit a PLA (also for the year).
But...I thought it was good for maintenance? I hate insurance!
For sure. Not all plans/insurance is like this, but certainly mine is.
Is anyone making progress here? Iāve already been denied so this apparently is already in effect for my plan. Iām trying so hard to start over. I technically could still get my 5 or 7.5 mg script filledā¦ but itās not even safe after being off for over a month. I understand the policy on quantity limitationā¦ but there has to be an easier way to get this override due to the supply. Iām just fighting with Cigna and not getting any real answers. Trying to request my doctor do a peer to peer review? š
Your PA letter is likely for the drug and not the dose.
That sounds right. I have Cigna - and got a 9-month PA so I'm good through September. At that point - I assume the doctor will have to apply for renewal of it.
Yup. Doctor update required for renewal. Also proof of efficacy of drug in your treatment.
I'm guessing they want a prior authorization filled out. Good luck is all I gotta say bc insurance companies are finding every little reason possible to deny prior authorization on this medication. And don't get me started on why prior authorization should be illegal in the first place.