Kei te Whakapaia e Anthem a Zepbound mo te Whakaiti Taumaha?

Kei runga i tō mahere motuhake. Kei te whakapaia e ētahi mahere Anthem a Zepbound mo te whakaiti taumaha, engari kāore te nuinga e pera. Ka nui te rerekē o te kapinga i runga i te momo o tō mahere, tō whenua, tō kaituku mahi, me te mea kei roto i te mahere ngā rongoā whakahaere taumaha i roto i tana rārangi.Kāore he whakautu ātea mō te āe, te kāore rānei e pā ana ki ngā mema katoa o Anthem, nō reira tirohia tō mahere takitahi.

He aha te nui o te rereke o te kapinga?

Ko Anthem tētahi o ngā kaiwhakarato inihua nui rawa atu i te whenua, engari ka whakahaerehia e ia puta noa i ngā momo hanganga mahere maha. Ko ngā mahere tautokohia e te kaituku mahi, ngā mahere whakataetae a te tangata takitahi, ngā mahere whakahaere a te Medicaid, me ngā mahere Medicare ka whai rārangi me ngā ture kapinga rerekē. He nui te reo o tō kaituku mahi ki te mea ka whakapaia e tō mahere ngā rongoā, otirā mō ngā mahere tautōpū-whaiaro.

Ko ētahi mahere Anthem ka whakakore rawa i ngā rongoā whakaiti taumaha mai i te kapinga. Ko ētahi atu ka whakauru i te Zepbound ki roto i tana rarangi, engari ka hiahiatia he whakaaetanga i mua me te taunakitanga o te tino tika o te hauora i mua i te whakaaetanga. Ko ētahi mahere i whakapaia ngā rongoā GLP-1 mo te whakaiti taumaha i ngā tau kua pahure ake nei kua timata ki te tango i taua kapinga na te nui o te utu o ēnei rongoā.

Hei tauira, ko ētahi mahere Blue Cross Blue Shield e hono ana ki Anthem i tango i te kapinga whakaiti taumaha GLP-1 i te taha o te tau 2025 me 2026. Ko te kaupapa Medi-Cal a California, tae atu ki te whakahaere a Anthem, ka mutu te whakapaia o Zepbound, Wegovy, me Saxenda mo te whakaiti taumaha i te 1 o Hānuere, 2026. Kāore ēnei huringa e pā ana ki ngā mema katoa o Anthem, engari e whakaatu ana me pēhea te tere o te whakarerekē o te kapinga.

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Me pēhea koe e kite ai mehemea ka whakapaia e tō mahere?

Ko te huarahi tino pono ko te tirotiro i te rarangi rongoā o tō mahere. Ka taea e koe te mahi mā te takiuru ki tō Pātūwāhi Mema Anthem, mā te waea rānei ki te nama Ratonga Mema Rongoā kua tā i runga i tō kāri inihua. Pātai motuhake mehemea ka whakapaia a Zepbound (tirzepatide) mō te tohu o te whakahaere taumaha roa, me te mea ka hiahiatia he whakaaetanga i mua, he maimoatanga taahiraa rānei.

Ka taea hoki e koe te whakamahi i te taputapu taki kapinga i runga i te paetukutuku mana o Zepbound. Ka hiahiatia e koe tō kāri inihua rongoā. Ka hoatu e te taputapu he aromatawai tere mehemea kei roto a Zepbound i tō mahere, ahakoa ehara i te tino whakapumautanga o te kapinga. Me whakapumau tonu ki a Anthem kia tino tika te whakautu.

Ka taea hoki e te tari o tō tākuta te āwhina. Ka taea e rātou te whakapā atu ki a Anthem i tō taha ki te whakapumau i te kapinga me te timata i te tukanga whakaaetanga i mua, ki te hiahiatia.

He aha te whakaaetanga i mua, he aha te mea nui?

Ko te nuinga o ngā mahere Anthem e whakapaia ana a Zepbound ka hiahiatia he whakaaetanga i mua i te whakaaetanga o te rongoā. Tīkanga tēnei me tuku e tō tākuta ngā tuhinga e whakaatu ana he tino tika te rongoā mō koe. Ko ngā whakaritenga noa ko te inemana BMI kua tuhia o te 30 teitei ake rānei (te 27 rānei teitei ake rānei me te mate honohono pēnei i te mate huka momo 2, te toto tiketike, te apnea moe rānei), ā, i ētahi wā, ko te taunakitanga kua ngana koe me te kore angitu ki ētahi atu huarahi whakahaere taumaha.

Ko ētahi mahere ka whakamahi hoki i te maimoatanga taahiraa, arā, me ngana koe ka kore e angitu ki ngā rongoā whakaiti taumaha iti ake te utu i mua i te whakaaetanga a Anthem i a Zepbound. Ka taea e tēnei tukanga te taapiri wiki ki te wā, nō reira ka pai te timata i mua ka mahi tahi ki tō tākuta mō ngā tuhinga.

Ko te whakaaetanga tuatahi i mua ka whakawhiwhia ki te ono marama. I te whakahoutanga, ka taea e koe te whakaatu kua tutuki koe i te 5% te iti rawa o te taumaha kua ngaro, te ahu whakamua rānei ki te whiwhi whakaaetanga anō.

Me pēhea mēnā kāore tō mahere Anthem e whakapaia?

Mēnā ka whakakore tō mahere i a Zepbound mō te whakaiti taumaha, kei a koe tonu ngā whiringa.

Ka whakawhiwhia e Eli Lilly tētahi kaupapa kārati whakaora mō ngā tangata whai inihua arumoni. Mēnā ka whakapaia e tō mahere a Zepbound, ka taea e te kārati whakaora te whakaheke i tō utu takoha ki te $25 anake ia marama. Mēnā kāore tō mahere arumoni e whakapaia, ka taea tonu e te kārati te tuku tae atu ki te $620 te whakaora ia marama, ka eke te utu ki te $499 ia marama mo te pene kotahi-wāhi.

Mō ngā tangata e pai ana ki te utu ki waho o te Putea, ka whakawhiwhia e te kaupapa utu-whaiaro a LillyDirect a Zepbound nga ipu kotahi-wāhi ka timata i te $299 ia marama mō te horopeta 2.5 mg. Ko ngā horopeta teitei ake ka rite ki te $399 ki te $449 ia marama. Kāore he inihua e hiahiatia ana, e whakaaetia ana hoki mō tēnei whiringa. He iti rawa ēnei utu i te utu rarangi o te $1,086 ia marama.

Ko ngā tangata whai inihua kāwanatanga pēnei i te Medicare, Medicaid, TRICARE, me ngā painga VAkāore e tika mō te kārati whakaora a te kaihanga. Heoi, ka rereke te kapinga a Medicaid i ia whenua, ā, ka taea te whakawhanui ake te kapinga a Medicare mō ngā rongoā momi i muri mai i te tau 2026.

Kei a koe hoki te mana ki te piira i te whakakorenga kapinga. Ka taea e tō tākuta te tuku tuhinga anō ki a Anthem e whakamārama ana he aha a Zepbound te mea tino tika mō tō āhuatanga. Mēnā ka whakakorehia te piira ā-roto, ka taea e koe te tono kia arotakehia waho mā tō tari inihua o tō whenua.

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Ka taea rānei e te whakaaetanga mo te moe apnea te āwhina?

Āe, tērā pea. I whiwhi a Zepbound i te whakaaetanga FDA motuhake mō te moe apnea obstructive, te mate tino nui, me te mate kino i roto i ngā pakeke kua momi. Ko ētahi mahere Anthem e whakakore ana i ngā rongoā whakaiti taumaha ka taea tonu te whakapaia a Zepbound i raro i tēnei tohu. Mēnā kei a koe he mate moe apnea kua tuhia me te rangahau moe e tika ana, ka taea e tō tākuta te rapu kapinga mā taua huarahi.

Me aha koe i muri mai?

Tīmata mā te tirotiro i tō rarangi me te waea atu ki a Anthem. Mēnā kei te wātea te kapinga, mahi tahi me tō tākuta ki te tuku i ngā tuhinga whakaaetanga i mua i te waea. Mēnā ka whakakorehia te kapinga, ka whakakorehia rānei, tirohia ngā whiringa kārati whakaora, te utu LillyDirect, me ngā whiringa piira. Ka tere te huringa o te whenua huri noa i te kapinga GLP-1, nō reira ka pai te taki anō i tō mahere i ia whakahoutanga.