Ingabe i-Anthem Ikhava i-Zepbound Yokunciphisa Umzimba?

Kuya ngohlelo lwakho oluthile. Ezinye izinhlelo ze-Anthem zihlanganisa i-Zepbound yokunciphisa umzimba, kodwa eziningi azikwenzi. Ukukhavwa kuyahlukahluka kakhulu kuye ngohlobo lwe plan yakho, isifundazwe sakho, umqashi wakho, nokuthi ngabe uhlelo luhlanganisa yini imithi yokuphatha isisindo kuhlu lwayo lwemithi. Akukhompendulo ejwayelekile ethi yebo noma cha esebenza kuwo wonke amalungu e-Anthem, ngakho-ke hlola uhlelo lwakho ngalunye.

Kungani Ukukhavwa Kuhlukahlukene Kangaka?

I-Anthem ingenye yezinkampani ezinkulu kakhulu zomshwalense ezweni, kodwa isebenza ngezindlela eziningi ezihlukahlukene zezinhlelo. Izinhlelo ezixhaswa ngamaqembu ezisebenzayo, izinhlelo zemakethe yomuntu ngamunye, izinhlelo zokuphatha i-Medicaid, kanye nezinhlelo ze-Medicare zonke zinezinhlu zemithi ezingafani kanye nemithetho yokukhavwa. Umqashi wakho unegama elikhulu kulokho imithi eyenziwa uhlelo lwakho ukuyihlanganisa, ikakhulukazi ezinhlelweni ezizixhasayo.

Ezinye izinhlelo ze-Anthem zikhipha ngokusobala imithi yokunciphisa umzimba ekukhaveni konke. Abanye bahlanganisa i-Zepbound kuhlu lwabo lwemithi kodwa badinga ukugunyazwa ngaphambili kanye nobufakazi bokudingeka kwezokwelapha ngaphambi kokuthi bayivumele. Futhi ezinye izinhlelo ezihlanganisa imithi ye-GLP-1 yokunciphisa umzimba eminyakeni edlule seziqale ukubuyisa ukukhavwa ngenxa yezindleko eziphezulu zalo migo. .

Ngokwesibonelo, izinhlelo eziningana ze-Blue Cross Blue Shield ezixhunywe ku-Anthem zabuyisa ukukhava kokunciphisa umzimba kwe-GLP-1 ziqala ngonyaka ka-2025 no-2026. Uhlelo lwe-Medi-Cal lwaseCalifornia, oluhlanganisa nokuphatha kwe-Anthem, lwaluqedile ukukhavwa kwe-Zepbound, i-Wegovy, kanye ne-Saxenda yokunciphisa umzimba kusuka ngoJanuwari 1, 2026. Lezi zinguquko azithinti wonke ilungu le-Anthem, kodwa zikhombisa ukuthi ukukhavwa kungashintsha kanjani ngokushesha.

[IMG:https://assets.getbeyondhealth.com/health-lib/blogs/manual_upload_20260213185401_timeline-zepbound.png]

Ungathola Kanjani Ukuthi Uhlelo Lwakho Luyihlanganisa Yini?

Indlela ethembeke kunazo zonke ukuhlola uhlu lwemithi ye plan yakho. Ungakwenza lokhu ngokungena ku-Anthem member portal yakho noma ngokushayela inombolo ye-Pharmacy Member Services ephrintwe ekhadini lakho lomshwalense. Buza ngokukhethekile ukuthi ngabe i-Zepbound (tirzepatide) ikhavwa yini ngenhloso yokuphatha isisindo njalo, nokuthi ngabe ukugunyazwa kwangaphambili noma i-step therapy iyadingeka.

Ungasebenzisa futhiithuluzi lokuhlola ukukhavwa kuwebhusayithi esemthethweni ye-Zepbound. Uzodinga ikhadi lakho lomshwalense wezithukuthuku eliseduze. Ithulusi linikeza isilinganiso esisheshayo sokuthi ngabe uhlelo lwakho luhlanganisa i-Zepbound, yize kungewona isiqinisekiso sokukhavwa. Ngalo lonke isikhathi hlola ngqo ne-Anthem ukuze uthole impendulo enembayo.

Ihholo lodokotela wakho lingakusiza futhi. Bangashayela i-Anthem esikhundleni sakho ukuze baqinisekise ukukhavwa futhi baqale inqubo yokugunyazwa kwangaphambili uma kudingeka.

Kuyini Ukugunyazwa Kwangaphambili Futhi Kungani Kubalulekile?

Izinhlelo eziningi ze-Anthem ezihlanganisa i-Zepbound zidinga ukugunyazwa kwangaphambili ngaphambi kokuthi zivume umuthi kadokotela. Lokhu kusho ukuthi udokotela wakho udinga ukuthumela amaphepha okubonisa ukuthi umuthi ubalulekile kwezokwelapha kuwe. Izidingo ezijwayelekile zihlanganisa i-BMI eqoshiwe engu-30 noma ngaphezulu (noma engu-27 noma ngaphezulu nenye inkinga ehlobene njengoshukela ohlobo lwesibili, umfutho wegazi ophakeme, noma i-sleep apnea), futhi ngezinye izikhathi ubufakazi bokuthi usuvele uzamile futhi awuphumelelanga ngezinye izindlela zokuphatha isisindo.

Ezinye izinhlelo zisebenzisa ne-step therapy, okusho ukuthi ungase udinge ukuzama futhi wehluleke ngemithi yokunciphisa umzimba engabizi kakhulu ngaphambi kokuthi i-Anthem ivume i-Zepbound. Le nqubo ingangeza amasonto esikhathini, ngakho-ke kusiza ukuqala kusenesikhathi futhi usebenze eduze nodokotela wakho emaphepheni.

Ukuvunywa kokugunyazwa kwangaphambili kokuqala kuvame ukunikezwa cishe izinyanga eziyisithupha. Lapho uvuselela, ungase udinge ukubonisa ukuthi usuhlohle isisindo esingu-5% noma wenza inququmela eqhubekayo ukuze ugunyazwe kabusha.

Kuthiwani Uma Uhlelo Lwakho Lwe-Anthem Lungaluvumeli?

Uma uhlelo lwakho lukhipha i-Zepbound yokunciphisa umzimba, usenezinketho.

U-Eli Lilly unohlelo lwekhadi lesaphulelo kulabo abanamazinga omshwalense. Uma uhlelo lwakho luhlanganisa i-Zepbound, ikhadi lesaphulelo lingaletha i-copay yakho ibe ngama- $25 kuphela ngenyanga. Uma uhlelo lwakho lokuphakathi lungaluhlanganisi, ikhadi lisengakwazi ukuhlinzeka ngokonga okungafika ku- $620 ngenyanga, liletha izindleko cishe ku- $499 ngenyanga ngepeni elilodwa. .

Kulabo abathanda ukukhokha imali ephuma ephaketheni, uhlelo lukaLilly LillyDirect lokukhokha lodwa lunikeza izikhuthazo ze-Zepbound zamalunga amabili kusuka ku- $299 ngenyanga ngomthamo we-2.5 mg. Imithamo ephezulu isukela ku- $399 kuye ku- $449 ngenyanga. Akukho mphakathi okudingekayo noma okwamukelekayo kulokhu kukhethwa. Lezi zintengo ziphansi kakhulu kunenani eliphelele cishe lika- $1,086 ngenyanga.

Abantu abanamazinga omphakathi njenge-Medicare, i-Medicaid, i-TRICARE, noma izinzuzo ze-VA abafaneleki ngekhadi lokonga lomkhiqizi. Noma kunjalo, ukukhavwa kwe-Medicaid kuyahlukahluka ngesifundazwe, futhi ukukhavwa kwe-Medicare kwemithi yokukhuluphala kungase kwandise kamuva ngonyaka ka-2026.

Uphinde ube nelungelo lokubuyekeza ukwenqatshwa kokukhavwa. Udokotela wakho angathumela amaphepha engeziwe ku-Anthem achaza ukuthi kungani i-Zepbound ibalulekile kwezokwelapha esimweni sakho. Uma isicelo sangaphakathi senqatshwa, ungacela ukubuyekezwa kwangaphandle ngokusebenzisa umnyango womshwalense wesifundazwe sakho.

[IMG:https://assets.getbeyondhealth.com/health-lib/blogs/manual_upload_20260213185339_options-anthem-zepbound.png]

Ingabe Ukugunyazwa kwe-Sleep Apnea Kungasiza?

Mhlawumbe. I-Zepbound yathola ukugunyazwa okuhlukile kwe-FDA kwe-obstructive sleep apnea emaphakathi kuya kokunzima kubantu abadala abanenkinga yokukhuluphala. Ezinye izinhlelo ze-Anthem ezikhipha imithi yokunciphisa umzimba zingase zisebenzise i-Zepbound ngaphansi kwalesi sigaba. Uma unokuqagela kwe-sleep apnea okubhalisiwe nophenyo olufanele lokulala, udokotela wakho angase akwazi ukulandela ukukhavwa ngalendlela kunokuba.

Yini Okufanele Uyenzele?

Qala ngokuhlola uhlu lwakho lwemithi bese ushayela i-Anthem ngqo. Uma kukhona ukukhavwa okutholakalayo, sebenzisa nodokotela wakho ukuthumela amaphepha okugunyazwa kwangaphambili ngokushesha ngangokunokwenzeka. Uma ukukhavwa kunqatshiwe noma kukhishiwe, hlola ikhadi lesaphulelo, izintengo ze-LillyDirect, kanye nezinketho zakho zokubuyekeza. Indawo ezungeze ukukhavwa kwe-GLP-1 iyashintsha ngokushesha, ngakho-ke kuyafaneleka ukuhlola kabusha uhlelo lwakho njalo lapho uvuselela.