Nakuba imithetho ye-Aetna mayelana nemithi yokunciphisa umzimba yenza izindaba unyaka wonke, impendulo yayo ye-Ozempic yahlala izinzile ngokuthula, ngoba i-Ozempic ihlala esigabeni esihlukile semihlomulo ngokuphelele.
Yebo, i-Aetna ikhava i-Ozempic ngo-2026 ngoshukela ohlobo lwe-2 cishe kuzo zonke izinhlelo zokuhweba, i-Medicare, ne-Medicaid, ngokuvamile njengomkhiqizo okhethwayo onemvume yangaphambili. I-CVS Caremark, umphathi wezindaba zemithi ye-Aetna, igcine i-Ozempic kumafomulari ayo ajwayelekile ngoba imithi yesifo sikashukela ihlala esigabeni semihlomulo esiyisisekelo abaqashi abangayisusi kaningi. Lokho i-Aetna engakwenzi ukuthi ikhweze i-Ozempic yokunciphisa umzimba, ngoba i-FDA ayizange iyivumele ngalolo setshenziswa; abafuna ukunciphisa umzimba bayiswa ku-Wegovy, i-GLP-1 okhethwa yi-Aetna ngalowo mgomo.
Nansi lokho okudingwa ukuvunyelwa, uzokhokha malini, imithetho yokugcwaliswa kabusha edida abantu, nendlela efanele uma ukunciphisa umzimba kuyinjongo yakho yangempela.
Indawo Ye-Ozempic Kumafomulari E-Aetna
I-Ozempic (semaglutide) ivezwa kumafomulari ajwayelekile e-CVS Caremark ase-Aetna njengomkhiqizo okhethwayo ngoshukela ohlobo lwe-2. Isigaba semithi sikhule ngo-2025: ngaphezu kokulawulwa kukashukela, i-FDA yayivumela ukunciphisa ingozi yezinhliziyo kubantu abanesifo sikashukela, futhi, ngoJanuwari 2025, ukuthambisa ukuqhubeka komfutho wezinso kubantu abadala abanesifo sikashukela sohlobo lwe-2 nesifo sezinso esingapheli. Njalo isibonakaliso sinikeza ababhala imiyalelo indlela enye evunyelweyo, futhi zonke ziyahlanganisa nokutholakala kwesifo sikashukela.
Imvume yangaphambili iphakathi kokuvamile. I-Aetna ngokuvamile icela ikhodi yokutholwa kwesifo sikashukela sohlobo lwe-2, umphumela wakamuva we-A1C, nobufakazi bokuthi uzamile i-metformin kuqala ngaphandle uma kungavunyelwe noma ingabekezeleki. Izimvume ngokuvamile zihlala izinyanga eziyi-12. Amanye amakhono ohlelo engeza imingcele yenani lokupakisha okumodeli eyodwa njalo emavikini angu-28, lokho kubalulekile lapho umthamo wakho ukhula; umbhali wakho angafuna ukukhishwa kumngcele wenani njengoba imithamo ishintsha.
Intengo Ye-Ozempic E-Aetna Ngo-2026
Ngokuvunyelwa okugunyaziwe, amalungu ezentengiselwano avamise ukukhokha izindleko zomkhiqizo okhethwayo zamaRandi angu-25 kuye kwayi-60 ngenyanga, futhi ikhadi lokonga elenziwe yiNovo Nordisk lingaletha iziguli ezihlomelisiwe ezisala phansi njengamaRandi angu-25. Amalungu ezinhlelo ezinokukhokhelwa okuphezulu akhokha inani elivumelanisiwe le-Aetna, ngokuvamile amaRandi angu-550 kuye kwayi-800, kuze kube yilapho ukukhokhelwa sekugcwalisiwe; izimali ze-HSA ziyasebenza.
Amalungu e-Aetna Medicare athola izivikelo zikahulumeni zango-2026: i-Medicare ikhokha inani elivumelanisiwe lamasenti angu-245 ngenyanga kusukela esivumelwaneni sikaNovemba 2025 esabikwa yi Axios, izindleko zigcina ku-Randi 50 ngenyanga, futhi i-Randi 2,100 yonyaka ye-Part D ebukhokhelwa ngaphandle yonyaka igcina unyaka. Amalungu e-Aetna Medicaid akhokha izindleko ezincane ezibekwe nguhulumeni, ngokuvamile kusuka ku-Randi 0 kuye kwayi-8.
Umbuzo Wokunciphisa Umzimba, Uphendulwe Ngokwethembeka
I-Aetna yenqena i-Ozempic eyalwe ukunciphisa umzimba, futhi izinhlelo zezidakamizwa zikhombisa izicelo ze-GLP-1 ukuqinisekiswa kokutholwa, ngakho-ke umlando ongavamile uvame ukufa esibambeni. Lokho akuyona inganekwane ye-Aetna; yilokho okusemqoka we-FDA. I-Semaglutide yokulawulwa kwesisindo ithengiswa njengo-Wegovy, futhi ngemuva kwesivumelwano seCaremark ngoJulayi 2025, i-Wegovy iyona i-GLP-1 okhethwa yi-Aetna yokunciphisa umzimba ezinhlelweni ezihlanganisa lesi sihlomelo, okuhlanganiswa nemibandela esekelwe ku-BMI.
Uma unezimo zombili zesifo sikashukela sohlobo lwe-2 kanye nokudla ngokweqile, ukutholwa kwesifo sikashukela ngokufanele kubangela imiyalelo ye-Ozempic. Uma unezinkwa eziningi ngaphandle kwesifo sikashukela, i-Wegovy iyona indlela ekhokhelwayo ku-Aetna, futhi i Zepbound idinga ukukhishwa kumafomulari kusukela ekungabandakanywa kwayo ngo-2025.
Ungathola Kanjani Ukugunyazwa Nokugcina Ukugunyazwa
Ukunikezwa kwemvume kokuqala: umbhali wakho ahambise ngogesi ngekhodi yokutholwa, i-A1C yakamuva, nomlando we-metformin unamathiselwe. Amafayela aphelele ahlanzwa emahoreni angu-24 kuye kwayi-72. Ukwenqatshelwa cishe njalo kubangelwa i-A1C engekho noma ubufakazi benkathi yokuqala obungekho, zombili zingalungiswa lapho zithunyelwa futhi.
Ukuhlala ugunyaziwe kuyinto abantu abayiphutha. Kalenda usuku lokuphela kwemvume, ngoba izivuseleli ezidlulile zidala izilinganiso ezingalindelekile ezingama-Randi angu-800. Isikhathi sokugcwalisa kabusha sibalulekile futhi: imingcele yenani isho ukuthi umthengisi akakwazi ukugcwalisa ngaphambi kwesikhathi, ngakho-ke cela izicelo zokuphuma ezingama-vacation ngaphambi kokuhamba. Uma amafomulari e-Aetna eshintsha okuncamelayo kwenye i-GLP-1 lapho kuvuselelwa (i-Mounjaro ne-Trulicity ziqhudelana esigabeni), imithetho yokuqhubeka kokunakekelwa ivumela iziguli ezizinzile ukuthi zicelle ukuhlala ku-Ozempic ngokusekelwa umbhali.
Imibuzo Evame Ukubuzwa
Ingabe i-Aetna ikhava i-Ozempic ngoshukela ohlobo lwe-2?
Yebo, cishe kuzo zonke izinhlelo, njengomkhiqizo okhethwayo onemvume yangaphambili. I-Aetna ngokuvamile idinga ukutholwa kwesifo sikashukela, i-A1C yakamuva, nokuzama i-metformin kuqala ngaphandle uma kungavunyelwe. Izimvume zihlala cishe izinyanga eziyi-12, futhi izindleko zentengiselwano ngokuvamile ziba phakathi kuka-Randi 25 kuye kwayi-60 ngenyanga, ngekhadi lokonga le-Novo elinciphisa izindleko ezifanele ziye ku-Randi 25.
Ingabe i-Aetna ikhava i-Ozempic yokunciphisa umzimba?
Cha. I-Ozempic ayivunyelwe yi-FDA yokunciphisa umzimba, futhi i-Aetna yenqena izicelo ezalelwe lo mgomo. Indlela ekhokhelwayo yi-Wegovy, i-GLP-1 okhethwa yi-Aetna yokunciphisa umzimba ezinhlelweni ezihlanganisa isihlomelo sokulawulwa kwesisindo, nemibandela ye-BMI 30+ (noma 27+ nesimo esihlobene nesisindo). Iziguli ezinesifo sikashukela kanye nokudla ngokweqile zifanelekela i-Ozempic ngokutholwa kwesifo sikashukela.
Kungakanani i-Ozempic nge-Aetna insurance?
Izindleko ezijwayelekile zentengiselwano ziba phakathi kuka-Randi 25 kuye kwayi-60 ngenyanga ngesigaba somkhiqizo okhethwayo ngemuva kokugunyazwa. Amalungu anezindleko eziphakeme zikhokha cishe amaRandi angu-550 kuye kwayi-800 kuze kube yilapho ukukhokhelwa sekugcwalisiwe. Amalungu e-Aetna Medicare akhokha kungabi ngaphezu kuka-Randi 50 ngenyanga ngaphansi komngcele kahulumeni ka-2026. Amalungu e-Aetna Medicaid akhokha kusuka ku-Randi 0 kuye kwayi-8 ngohulumeni wesifundazwe.
Kungani isicelo sami sokugcwalisa kabusha i-Ozempic se-Aetna senqatshiwe?
Izizathu ezijwayelekile: imvume yangaphambili ephelelwe yisikhathi (iyivuselele), umngcele wenani uhlangana nokushintsha komthamo (cela ukukhishwa), noma ukugcwaliswa kabusha okufika ngaphambi kwesikhathi. Ngokungavamile, ukuncintisana kweplan kushintshe ukuncanyelwa lapho kuvuselelwa. Shayela ulayini we-pharmacy ekhadini lakho ukuze uthole ikhodi yokwenqatshelwa eqondile, bese umbhali wakho alungisa leyo nto ethile.
Ingabe i-Aetna ikhetha i-Ozempic noma i-Mounjaro ngoshukela?
Zombili zivame ukuvela kumafomulari e-Aetna, nokuncanyelwa kuyahlukahluka kuye ngonyaka weplan kanye nomklamo. Amanye ama-plan asebenzisa imiyalelo yenkathi yokwelapha i-oda eyodwa ngaphambi kwenye. Uma uzinzile ku-Ozempic futhi ushintsho lokuncanyelwa ekupheleni konyaka lukhomba ku-Mounjaro, umbhali wakho angacela ukunakekelwa ukuqhubeka nokusebenza ukuze uhlale kuwo umuthi osebenzayo.
