At the beginning of the year my insurance switched from BCBS to Aetna. I was on Zepbound for about 14 months at this point. Around March I ran out of Zep and went to my doctors because my new insurance will cover Wegovy (Zep not in formulary).
Switched to Wegovy but the side effects are awful. Bad Bloating and gas, hunger not suppressed, never getting full. Also gained 12 pounds in it so far. (Mid March to beginning of May)So I asked my Doctor to submit a PA for Zepbound since I tried and failed Wegovy.
2 PA’s have been denied and my appeal was denied as well. The reason they give me is because my BMI isn’t high enough. I called my doctors office and they swear left right and center that they entered my starting weight from 2024(when started Zep)when they did the PA’s and appeal. I have a copy of the appeal where a question about BMI was answered yes when it should have been answered no . (See pic question 10) My doctors office swears the answered the question No. Even brought the office manager in to look at their screen where it says no.
I’m at my wits end about what to do. My doctors office says they won’t do anything more unless they get something from insurance to fill out. I reached out to my works Benefits department to see if I can get some help that way. Also reached out through Aetna insurance to get a case manager to try and help.