I am changing insurance, will my insurance still cover my medication?
We were recently made aware that starting January 1, 2025 some insurance benefits are changing in ways that will impact coverage of injectable weight loss medications such as Saxenda, Wegovy, and Zepbound.
As insurance plans are different for each individual, there is no way for Form Health to automatically know what changes may or may not occur. Therefore, we encourage you to take the following steps to review your insurance coverage to avoid any disruptions in your treatment.
Note: if you are paying for your medication entirely out-of-pocket (cash pay) this does not apply to you. Specifically, this is for patients who currently have their medication covered by insurance.
- Confirm your medication coverage:
- Contact your insurance provider: Call the customer service number on the back of your insurance card or log in to your insurance portal online.
- Search the formulary: Ask about or search for your plan’s prescription drug formulary for 2025. Confirm whether your current medication is still covered.
- Check the tier status: It’s recommended you also confirm whether your medication remains on the same tier (cost level) or if there are changes to this which would impact the out-of-pocket cost to you.
- Review any notices: If you have received a letter from your insurance informing you of changes to your medication coverage, take note of these details and bring them to your appointment to discuss with your clinician. You can also upload a copy of the letter to the portal at https://my.formhealth.io/upload or fax to 617-928-8401.
- Schedule an appointment with your clinician before the end of the year
- If you find that your medication is no longer covered, may no longer be covered, or if the cost has changed significantly you’ll want to discuss the next steps or explore alternative options.
- If you’re unable to schedule an appointment, please contact our support team through the chat for further assistance.
- Request refills before the end of the year
- If appropriate, your clinician may try to prescribe a 60-90 day supply (rather than 30 day) that you would pick up as your last refill for 2025. Note that insurance typically limits refills to be filled at least 3 weeks after the last prescription was picked up. Therefore, if you are due to pick up a prescription in December, you may first want to check with your pharmacy to see if they have an order for 1 month or greater on file and if they can fill more than 1 month at that time. If they do not have an order for more than a 30 day supply then contact your clinician. Note: insurance companies may limit you to only one 30 day supply per month.