Formulary Question…

I am taking Zepbound. It is a pen injection, once a week. It comes in different strenths measured in mg but all the same volumes, measured in mL. Generally, when on it, you start low, then build up gradually in strenghs to keep the side effects at bay. The higher the dose, the more effective it is. Everyone is different and how long they stay on a particular level can vary.

My major, nationwide, mail-order insurer/pharmacy has the following rules:

2.5mg/0.5mL: 2mL in any 365 day period. 5.0mg/0.5mL: 6mL in any 63 day period. 7.5mg/0.5mL: 2mL in any 365 day period. 10mg/0.5mL: 6mL in any 63 day period. 12.5mg/0.5mL: 2mL in any 365 day period. 15mg/0.5mL: 6mL in any 63 day period.

Now while it is true patients are supposed to keep moving up, there has been shortages and moving up and down is common. You need to move back down if you are off of it for more than 2 weeks. I have been in that situation twice now. Moving back down to 2.5 or 7.5 is not possible unless I wait a year. So, I have been living with the side effects.

My appeal was denied.

The ironic part? The list price on the restricted doses are one third cheaper! ALL OF THEM!

My main question is, why on earth would someone think this is a good idea?

submitted by /u/haemaker
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