Mbese Blue Cross Yishyura Zepbound?

Kwishyurwa kwa BCBS kwa Zepbound biratandukanye cyane bitewe n'umushinga wawe, leta yawe, n'impamvu imiti yanditswe. Imishinga myinshi ya BCBS isanzwe ntabwo isanzwe yishyuza Zepbound kugabanya ibiro. Imishinga imwe yishyura hamwe uruhushya rubanza, kandi imishinga ya konte ye yishyurwa binyuze ku bukoresha ifite uburyo bworoshye cyane. Reka turebere hamwe uko byose bikora.

Kuki Kwishyurwa Gutandukanye Cyane Na BCBS?

Bitandukanye n'abandi bishyura benshi, Blue Cross Blue Shield ntabwo ari isosiyete imwe. Ikora nk'umuryango uhuza abatwara ibyemezo byigenga mu gihugu hose. BCBS ya Michigan ifite politike zitandukanye na BCBS ya Tennessee, nayo itandukanye na BCBS ya Illinois.

Burimwese uyobora ashiraho urutonde rw'imiti yishyuwe (urubanza rw'imiti yishyuwe) n'amategeko ye yo kubanza uruhushya. Kuri ibyo, abakoresha bashyira mubikorwa gahunda z'ubuvuzi za BCBS bashobora guhitamo kwemeramo cyangwa kwanga imiti yo gucunga ibiro burundu. Ibi bisobanura ko abantu babiri bari mu ntara imwe bafite uburyo bwa BCBS bashobora kubona ibisubizo bitandukanye ku bijyanye no kwishyurwa kwa Zepbound.

Ni ubuhe buryo bwa BCBS bushobora Kwishyura Zepbound?

Iyo urebye urutonde rw'imiti mu bigo byinshi bya BCBS, ni bake gusa mubyumva bashyiramo Zepbound ku rutonde rw'imiti yabo. Dore uko amoko y'imishinga atandukanye asanzwe abikora.

Imishinga y'abakoresha bashyira mubikorwa niyo ishobora kwishyura Zepbound. Muri iyi mishinga, umukoresha wawe afata imyanzuro yo kwishyurwa, kandi BCBS isigaye igenzura inyungu. Bamwe mu bakoresha bahisemo kwemeramo imiti ya GLP 1 yo gucunga ibiro nk'igice cy'inyungu zabo. Niba ukorera isosiyete nini, birakwiye kwibaza ibyo kwa sekreta w'abakozi bawe.

Imishinga y'abakoresha bakorana niyo ibona ibibazo bikomeye. Bimwe mu bigo bya BCBS byirukanye imiti ya GLP 1 yo kugabanya ibiro ku rutonde rw'imiti y'abarwayi kuva ku ya 1 Mutarama, 2025. BCBS ya Massachusetts yatangaje ibibazo bisa kuva ku ya 1 Mutarama, 2026. BCBS ya North Dakota nayo yakoze impinduka mu kwishyurwa kw'imiti yo kugabanya ibiro kuva 2026, ivuga ibiciro byiyongera.

Imishinga y'Abakozi ba Leta (FEP) ifite urutonde rw'imiti yayo. Kugeza ubu, Zepbound ishobora gusaba uruhushya rw'ikiguzi kugirango yishyuwe. Niba byemewe, byakwicara muri Tier 3 (ntabwo byihutirwa) mu mishinga myinshi ya FEP.

Imishinga ya Medicare na Medicaid BCBS. Imishinga myinshi ya BCBS Medicare ntishyuza Zepbound kugabanya ibiro. Kwishyurwa bishobora kuba bishoboka niba imiti yanditswe kubera ibibazo by'ubuhumekero bwo gusinzira (obstructive sleep apnea). Kwishyurwa kwa BCBS Medicaid gutandukana ku ntara. Bimwe mu bigo bya leta bishobora kwishyura Zepbound kubyo gusinzira ariko bikanga kubwo kugabanya ibiro.

Ibisabwa Na BCBS Kugirango Yishyure Zepbound?

Ku mishinga ya BCBS yishyura Zepbound, uruhushya rubanza rusabwa kenshi. Umuganga wawe azagomba kohereza inyandiko kuri BCBS ibigaragaza ko imiti ikenewe mu buryo bw'ubuvuzi.

Ibisabwa bisanzwe birimo BMI y'inyandiko 30 cyangwa hejuru, cyangwa BMI y'inyandiko 27 cyangwa hejuru hamwe nibibazo nibura kimwe bifitanye isano n'ibiro nk'ubwoko bwa 2 bwa diyabete, umuvuduko ukabije w'amaraso, cyangwa ibibazo by'ubuhumekero bwo gusinzira. Imishinga myinshi nayo isabwa n'ikigeragezo cy'uko wakoze gahunda yo gucunga ibiro irimo ibiryo, imyitozo ngororamubiri, ningingo zo kwigana imyitwarire imara amezi atandatu.

Imishinga imwe nayo isaba kwifashisha imiti ya mbere. Ibi bisobanura ko uzagira ikizamini kandi ugabanye ibindi miti yishyuwe (nk'U Wegovy, Saxenda, Qsymia, cyangwa orlistat) mbere yuko BCBS yemerera Zepbound. Kandi kugirango ugumane kwishyurwa, imishinga imwe isabwa n'inyandiko igaragaza ko uguma kugabanya ibiro mu gihe ufata imiti.

Bite Noneho Niba BCBS Yanga Kwishyura Zepbound?

Kwemera kwanga ntibikomeye ko ari iherezo. Ufite uburenganzira bwo gusaba gusubiramo, kandi impinduka zihamye zihamye kuruta uko abantu benshi babyitega. Ubushakashatsi bwagaragaje ko hejuru ya 80% by'ubusabe bwo gusubiramo kwirukanwa byahinduwe igihe byanditswe neza. Ariko munsi ya 10% by'abarwayi bahamagara ubujurire.

Niba wabuze ubujurire, tangira urebye inyandiko yawe y'ihakemurwa. Izagutagaragaza impamvu kandi igaragaze amahitamo yawe yo gusaba gusubiramo. Kora n'umuganga wawe kugirango uhuze inyandiko zemeza, harimo inyandiko z'ubuvuzi, amateka ya BMI, ibizamini by'amaraso, n'ibimenyetso kubijyanye n'uburyo bwo kugabanya ibiro mbere. Niba Zepbound irimo ku rutonde rw'imiti rwose, ushobora kohereza ubusabe bwo kugaburira urutonde rwerekana impamvu ibindi bikoresho byishyuwe bidakwiye kuri wowe.

Ni ubuhe buryo ufite Niba BCBS Itazishyura Zepbound?

Ndetse no ntibyishyurwa, hari uburyo bwo gukora Zepbound bihendutse.

Ikarita yo Kubika Zepbound ituruka kuri Eli Lilly ishobora kugabanya igiciro kugeza kuri $ 25 ku kwezi niba umushinga wawe w'abakoresha wishyura Zepbound. Niba umushinga wawe utayishyuza, ikarita yo kubika ishobora kugabanya igiciro kugeza kuri amadorari 499 buri kwezi kubwinzi bw'umuti w'umwe.

LillyDirect itanga amadorari ya Zepbound amwe amwe ku giciro cy'amafaranga kigatangira ku $ 299 kugeza $ 449 buri kwezi bitewe n'umuti. Ibi byirinda ubwishingizi burundu kandi biraboneka kuri buri wese ufite imiti.

BCBS nayo yishyura imiti myinshi yo gucunga ibiro ishobora kuba ikwiye kuganira n'umuganga wawe, harimo Wegovy, Saxenda, Qsymia, na orlistat.

Uburyo Bwo Kwifotora Ubuvuzi Bwawe Bwa BCBS

Kuko kwishyurwa gutandukanye cyane, kwifotora umushinga wawe ni ingenzi. Fungura urubuga rwa BCBS rw'abanyamuryango kandi ukoreshe ubushakashatsi bw'imiti kugirango urebe Zepbound. Urashobora kandi guhamagara nimero y'abakiriya kuri ikarita yawe y'ubwishingizi maze ukabaza niba Zepbound iri ku rutonde rwawe rw'imiti kandi ni ibihe bisabwa byo kubanza uruhushya bikoreshwa. Niba ufite umushinga w'abakoresha, twandikire kuri HR kubijyanye n'uko isosiyete yawe yishyuza imiti yo gucunga ibiro.

Ibyo Umunsi By'ingenzi

Ku mishinga isanzwe myinshi, kwishyurwa kugabanya ibiro birugorana cyangwa byirukanwe. Ariko imishinga y'abakoresha bashyira mubikorwa, abatwara leta bamwe, nibyo gusinzira bishobora gutuma ibintu byoroha. Niba wabuze, gusaba gusubiramo hamwe n'inyandiko z'inyandiko birakwiye ko bikorwa. Kandi niba kwishyurwa bidahari, ikarita yo kubika na LillyDirect bitanga inzira nyazo zo kugabanya igiciro.

Ibi bimenyetso biheruka: Ibi byose ni ibyo kumenya gusa kandi ntibishobora gusimbura inama z'umuganga cyangwa zubwishingizi. Politike zo kwishyurwa zihinduka kenshi. Koresha buri gihe inyungu zawe ufiteho neza na BCBS yawe kandi ugishakira inama y'umuganga wujuje ibisabwa kugirango ufate imyanzuro y'ubuvuzi.