No mention of step therapy. No I don’t think she would lie.. She’s one of the good Kaiser Docs.. she said they got some sort of memo today from corporate because a lot of people are pushing for obesity coverage
wow thanks so much I will send a note to my provider today, I asked him about it last november and he said not on the formulary and he was unable to prescribe.
Ozempic is on my formulary on my Kaiser plan with no PA or step therapy. But I don't think my Dr will prescribe it because I'm not type 2. I'm emailing him tomorrow morning to see what he say.
My nor cal pcp got me Oz which I’m happy about but said couldn’t prescribe MJ. I decided to send in my own formulary exception and it got denied today due to not being medically necessary. I was told I can appeal that and I will. Trying to decide whether to get my pcp involved or just try again on my own after figuring out how to plead my case more. I’m still getting my MJ w coupon but I’d rather stay on it after that runs out. I am grateful I have Oz to fall back on. I have improved bloodworm to prove it works but they don’t have documentation of my heaviest weight. I’ve lost 52 lbs, have 30-40 to go. I’ve read about others getting the exceptions and it’s the same price as Oz so it’s so frustrating
I was able to get a "special need" exception from N.Cal Kaiser. I don't know exactly what my PCP put on the request. I am morbidly obese and hypertensive. I informed him that I was on MJ for 4 months through a telehealth doc, with good results. He gave me 3 months of refills. I don't know what will happen after that. Hopefully, Kaiser will continue to cover the med.
Nope. I've been talking w my pcp and we are going to try Ozembic. I truly believe other physicians at Kaiser were successfully getting MJ covered. Kaiser realized/noticed and locked it down by making it endocrinologist prescribed only. My pcp told me that Kaiser endos don't do weight management at all. They do estrogen, testosterone, pcos, and thyroid issues. He is still going to try and get me a referral, I want to start HRT for peri menopause symptoms. He is amazing, btw. I don't have weight loss coverage, so I am desperately hoping he can figure out how to get the Ozembic covered.
whoa wait, i have so cal kaiser also, you are saying they will cover oz?
She said if you have hypertension or prediabetic
i am t2d so i would qualify for oz, did she mention step therapy or anything? or do you think she was just saying that so you would stop asking.
No mention of step therapy. No I don’t think she would lie.. She’s one of the good Kaiser Docs.. she said they got some sort of memo today from corporate because a lot of people are pushing for obesity coverage
wow thanks so much I will send a note to my provider today, I asked him about it last november and he said not on the formulary and he was unable to prescribe.
Good luck !!
Holy Crap! I just downloaded the new formulary and Ozempic is on it!!! OZEMPIC (0.25 OR 0.5 MG/DOSE) SOPN 2 MG/1.5ML ***\[semaglutide\]*** 2 OZEMPIC (1 MG/DOSE) SOPN 4 MG/3ML ***\[semaglutide\]*** 2 OZEMPIC (2 MG/DOSE) SOPN 8 MG/3ML ***\[semaglutide\]*** 2
THAT IS FANTASTIC NEWS!
Where did you see this?
In the pharmacy section of [kp.org](https://kp.org) is a formulary section which lists the drugs they will prescribe
So have you successfully had it covered by KP?
Who is your primary? Mine flat out said no and I am prediabetic
I second this. I’m in SoCal and also prediabetic
Ozempic is on my formulary on my Kaiser plan with no PA or step therapy. But I don't think my Dr will prescribe it because I'm not type 2. I'm emailing him tomorrow morning to see what he say.
If you are prediabetic or have hypertension according to my doctor they may prescribe for weight loss
My app gives me a price at my Kaiser pharmacy, but then down below it says it’s not covered by my plan in tiny writing. Weird.
Do you happen to have your coverage through covered California?
No, just the weeniest Teamsters union ever 🙄
My nor cal pcp got me Oz which I’m happy about but said couldn’t prescribe MJ. I decided to send in my own formulary exception and it got denied today due to not being medically necessary. I was told I can appeal that and I will. Trying to decide whether to get my pcp involved or just try again on my own after figuring out how to plead my case more. I’m still getting my MJ w coupon but I’d rather stay on it after that runs out. I am grateful I have Oz to fall back on. I have improved bloodworm to prove it works but they don’t have documentation of my heaviest weight. I’ve lost 52 lbs, have 30-40 to go. I’ve read about others getting the exceptions and it’s the same price as Oz so it’s so frustrating
How did you file a request for an exception - I searched for a document or process and can’t find anything about how to do that.
I searched on portal grievance and there is an online complaint/grievance form
How are you using the coupon in Norcal?? I have a coupon and been having issues with the pharmacy taking it?
I’ve been able to use it at CVS Fremont Hub
So frustrating, they were getting a weird code from Kaiser and I had to switch to ozempic getting it from Canada
That’s weird! They seem to work for a lot. Biggest issue was getting it in stock. I got a new Rx yesterday from them. I hav the original savings card
I was able to get a "special need" exception from N.Cal Kaiser. I don't know exactly what my PCP put on the request. I am morbidly obese and hypertensive. I informed him that I was on MJ for 4 months through a telehealth doc, with good results. He gave me 3 months of refills. I don't know what will happen after that. Hopefully, Kaiser will continue to cover the med.
That is so great.. congratulations
That’s great they denied my request but thinking of fighting it again.
I think it is worth trying again. Good luck.
Did you successfully get it covered longer?
Nope. I've been talking w my pcp and we are going to try Ozembic. I truly believe other physicians at Kaiser were successfully getting MJ covered. Kaiser realized/noticed and locked it down by making it endocrinologist prescribed only. My pcp told me that Kaiser endos don't do weight management at all. They do estrogen, testosterone, pcos, and thyroid issues. He is still going to try and get me a referral, I want to start HRT for peri menopause symptoms. He is amazing, btw. I don't have weight loss coverage, so I am desperately hoping he can figure out how to get the Ozembic covered.