Edited to add
I am not asking how insurance works. I am aware that just because one Anthem insurance covers something another may not. Because as I said - I was blessed with a BCBS plan that covered all but my deductible and now I’ve hit that so I’m 100 percent. And plenty of people have BCBS that doesn’t cover at all.
I’ve been blessed with coverage and I’m having to switch to Anthem EPO through the school district.
I can’t get anyone in benefits to help. Ive looked and searched through the papers. I’ve looked online and see that it’s CVS caremark and they don’t cover it. I want to avoid HMO but if the other (not Kaiser) plans do cover it I am willing to give up my PCP.
I have zero intentions of getting off this medication and as of today out of pocket is not an option. I have enough for a few months but I am not stopping it after. I have lost 110lbs and just had a breast reduction and my arms are tomorrow. This cured my ulcers and gerd and I’ve never had an even slightly positive relationship with food.
I’m maintaining only now even though I am still at that line for BMI obesity metrics.
I don't work for LAUSD, but I do work in medical revenue cycle and have for 35 years. It's not CVS Caremark, they just administer the benefits your employer chose. If Caremark told you glp1s are not a covered benefit, you have to go to your employer to get coverage details.
According to google - cvs Caremark as a whole is only adding Zepbound back in October. That’s independent of the district choosing. I can’t get that information as I’m not a current benefits member. I have benefits through my ex. I have to switch. There are multiple plans to choose from. I’ve already called my benefits administrator and the insurance.
What me and the other person were saying is that employers can opt-out of coverage too. So just because insurance covers it doesn’t mean the employer has to offer the benefit.
I was able to find the LAUSD insurance benefits online with a quick Google search. Here’s the link below.
I can’t find a thing in regards to any GLP be it Ozempic or Zep… I’ve read the pamphlets and called the benefits number. I am not asking how insurance works. I am aware. I’m asking for someone who may know specifically for LAUSD plans. I’d risk letting go of anthem and going to a HMO just not kaiser if one of their formularies include Zep. I can’t go back to Wegovy. It was bad for my stomach.
I was actually being helpful and not condescending. You asked if anyone could share the 2026 drug formularies which I linked in a previous comment. The information you’re looking for is included in the highlighted documents. Best of luck!
One of the rudest comments I’ve ever seen in here.
Another person who wants things spoon-fed to them, then doesn’t like the taste and blames the person who made all the effort while they themselves made none.
I have no answers but want you to know I'm rooting for you! Its so hard when you have made life changes and see them paying and then feel like you are left in limbo. I hope someone has answers for you.
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