Yimikinga Umshwalense Ukukhava iZepbound?

I-Zepbound (tirzepatide) isisheshise yaba ngelinye lamaphilisi okunciphisa umzimba axoxwa kakhulu emakethe. Iklanywe yi-Eli Lilly, isebenza ngokuvula ama-receptor amabili ama-hormone i-GIP ne-GLP 1 okusiza ukunciphisa ukulamba, ukulawula ukudla okudliwayo, nokusekela ukuphathwa kwesisindo isikhathi eside. Iphinde ibe nemvume ye-FDA yokwelapha i-obstructive sleep apnea emaphakathi kuya kokubucayi kubantu abadala abakhuluphele.

Kodwa-ke, nansi into eyenza abantu abaningi banqikaze: ukwenza umshwalense ukuthi ukukhokhele ngempela. Isiphazamisi esisodwa sanyanga zonke se-Zepbound sibiza cishe u-$1,554 ngaphandle kokukhava, ngakho-ke ukuthola izinketho zomshwalense akusizi nje kuphela - kubalulekile. Lo mhlahlandlela uchaza ukuthi yimaphi amaphilisi omshwalense akukhava i-Zepbound, ukuthi yini ongayilindela kule nqubo, nokuthi yini okufanele uyenze lapho ukukhava kunqatshelwa.

Ingabe Umshwalense Ukukhava iZepbound?

Impendulo emfushane - kuncike. Ukukhava kuyahluka kakhulu kuye ngohlobo lwephirisi, umshwalense, ngisho nomqashi ohlinzeka ngephirisi. Amanye amaphilisi omshwalense azimele ayawukhava i-Zepbound ngaphansi kwezinkokhelo zamaphilisi ezibhalisiwe, kodwa cishe njalo iza nezimo ezifana nokugunyazwa kwangaphambili noma imikhawulo ye-formulary.

Ngokusho kwedatha yakamuva evela kuGoodRx, cishe u-56% wabantu abanamshwalense azimele abakhona njengamanje abanawo nhlobo ukukhava kwe-Zepbound. Lelo nombolo liyakhule kakhulu kusukela i-CVS Caremark yanquma ukukhipha i-Zepbound kwi-formulary yayo ejwayelekile phakathi kuka-2025. Ngakho-ke, yize ukukhava kukhona, akukona konke okukhona.

Amaphilisi Azimele kanye Ahlinzekwa Ngabaqashi

Umshwalense ohlinzekwa ngabaqashi uhlala uyindlela eningi kakhulu yokuthola ukukhava kwe-Zepbound. Lawa maphilisi - kungaba ngokwenkampani enkulu noma ibhizinisi elincane - angase afake i-Zepbound ku-formulary yawo, kodwa kaningi njengephirisi lezinto ezikhethekile elinezinkokhelo eziphakeme noma i-coinsurance.

Lokho kusho, abaqashi banelungelo lokukhetha ukuthi ama-medications okuphatha isisindo afakwe noma cha. Kuphela cishe u-19% wamaphilisi ezempilo abaqashi abakhulu abakhava ama-medications e-GLP 1 njenge-Zepbound ukuze anciphise umzimba. Uma umqashi enqaba, ukukhava ngeke kube khona - kungakhathaliseki ukuthi umshwalense unikeza ngani.

Iziguli ezikhokhelwa ngaphansi kwamaphilisi azimele ane-Zepbound ku-formulary yazo zingasebenzisa i-Zepbound Savings Card evela ku-Eli Lilly ukukhokha njengokuncane njengo-$25 ngenyanga. Kulabo abanamaphilisi azimele angakhawi i-Zepbound, ikhadi lokonga liyanciphisa kube cishe u-$499 ngenyanga.

Yimaphi Ama-Insurer Amakhulu Akukhava iZepbound?

Izinqubomgomo zokukhava ziyahlukana phakathi kwama-insurer, futhi ngisho naphakathi kwenkampani efanayo, amaphilisi angahluka. Nansi ukubuka okujwayelekile lapho abadlali abakhulu bemi khona.

Blue Cross Blue Shield (BCBS)

Ukukhava ngeBlue Cross Blue Shield kuncike kakhulu kuphirisi elithile. Amanye amaphilisi e-BCBS ayakukhava i-Zepbound ukuze anciphise umzimba ngokugunyazwa kwangaphambili, kanti amanye ayakuchitha nhlobo ama-medication okunciphisa umzimba. Amaphilisi awakhava avame ukufuna i-BMI engu-30 noma ngaphezulu, noma engu-27 nangaphezulu enesimo esihlobene nesisindo.

UnitedHealthcare

Amaphilisi eUnitedHealthcare ayahluka kuye ngomqashi nangesifunda. Amanye amaphilisi afaka i-Zepbound nezidingo zokugunyazwa kwangaphambili, kanti amanye awafakile ku-formulary yawo. Ukubheka ngephirisi elithile kuyindlela eyodwa eqinisekile yokwazi.

Aetna

IAetna inikeza ukukhava ngaphansi kwamaphilisi athile, ikakhulukazi lawo afaka izinzuzo zokuphatha ukukhuluphala. Ukugunyazwa kwangaphambili kanye nesidingo sezokwelapha esibhaliwe kuvame ukufunwa.

Cigna

Ukukhava kweCigna nakho kuncike kuphirisi ngamunye. Amanye amaphilisi e-Cigna ahlinzekwa ngabaqashi ayakukhava i-Zepbound; amanye awakhawi. Iziguli kufanele zithinte i-Cigna ngqo noma zibheke i-formulary yazo.

Kaiser Permanente

Ukukhava kweKaiser Permanente kuncike esifundeni naphrisini. Amanye amaphilisi eKaiser ayakukhava i-Zepbound ngeziguli ezine-BMI engu-30 noma ngaphezulu, noma engu-27 nangaphezulu nenkinga ehambisana nayo. Abaningi bafuna ukuzama amanye ama-medication okunciphisa umzimba kuqala, futhi ukugunyazwa kwangaphambili kuvamile.

Kuthiwani Nge-Medicare Ne-Medicaid?

Lapha yilapho izinto ziba nzima khona. Ngokwesiko, i-Medicare ayizange ikhwe yizinto ezi-prescribed ngokuqondile ukuze kuncishiswe umzimba. Kodwa-ke, amaphilisi e-Medicare Part D angasekhava i-Zepbound lapho ichazwa njengomphumela we-obstructive sleep apnea (enye i-FDA approval use). Amanye amaphilisi e-Medicare Advantage angase futhi anikeze izinzuzo ezingeziwe ezungeze ukuphathwa kwesisindo.

Kukhona futhi intuthuko ebalulekile ezayo. Isivumelwano phakathi kwe-Eli Lilly nohulumeni wesifederal kulindeleke ukuthi silethe ukukhava kwe-Medicare nge-Zepbound yokukhuluphala ne-comorbidities phakathi no-2026, ngokulindeleka kwe-copay engaba ngu-$50 ngenyanga.

Ukukhava kwe-Medicaid kuncike ngokuphelele esifundeni. Kuphela cishe izifunda ezingu-13 ezikhona njengamanje ezikhava ama-medications e-GLP 1 ukuze kuncishiswe umzimba nge-Medicaid, futhi izidingo zivame ukuqina (zivame ukufuna i-BMI engu-35 kuya ku-40). Ukukhava kungashintsha futhi maphakathi nonyaka. Isivumelwano esafinyelelwa ekupheleni kuka-2025 ne-Eli Lilly ne-Novo Nordisk kusho ukuthi zonke izifunda ezingu-50 zingase zamukele amanani aphansi e-Medicaid ngo-2026, kodwa ukwamukelwa kuzohluka.

Isebenza Kanjani Ukugunyazwa Kwangaphambili?

Phantse wonke umshwalense okukhava i-Zepbound uzofuna ukugunyazwa kwangaphambili. Lokhu kusho ukuthi umhlinzeki wezempilo udinga ukuhambisa amadokhumende kumshwalense echaza ukuthi kungani i-medication iyisidingo sezokwelapha.

Izidingo ezijwayelekile zifaka i-BMI ebhalisiwe engu-30 noma ngaphezulu (noma engu-27 nangaphezulu enezimo ezifana nokufutha kwegazi okuphezulu, uhlobo lwesi-2 lwesifo sikashukela, noma i-cholesterol ephezulu), amarekhodi ezinyathelo zokuphatha isisindo zangaphambili ezifana nokudla, ukuzivocavoca, noma amanye ama-medication, kanye nomlando wezokwelapha ofanele. Izinqumo ngokuvamile zibuyela emuva zingakapheli izinsuku ezingu-3 kuya kwezi-7.

Nansi iqiniso noma kunjalo - kufika ku-70% wezicelo zokugunyazwa kwangaphambili ze-Zepbound ziyangqatshelwa. Lokho kuzwakala kuyadumaza, kodwa akumele kube ukuphela komgwaqo.

Okufanele Kwaziwe Uma Ukukhava Kunqatshelwe?

Ukuthola ukwenqatshelwa kuyadumaza kodwa kuvamile kakhulu. Izindaba ezinhle ukuthi ngaphezu kuka-65% weziguli ezidlulisa ukwenqatshelwa kwe-Zepbound ziwina udaba lwazo. Kodwa-ke, ngaphansi kuka-12% weziguli zizihlupha ukufaka eyodwa. Lo mgozi umele ithuba elikhulu elilahlwe.

Izinyathelo ezibalulekile zokuthatha ngemuva kokwenqatshelwa zifaka ukubheka incwadi yokwenqatshelwa ngokucophelela ukuze kuqondwe isizathu esithile, ukusebenza nomhlinzeki wezempilo ukuze kuqoqwe amadokhumende angeziwe noma kulungiswe imininingwane engekho, ukuhambisa isikhalazo esisemthethweni nencwadi yesidingo sezokwelapha, nokuxhumana nomshwalense ngqo ukuze kuxoxwe ngesinqumo.

Uma iphrisi elinikezwa ngumqashi likuchitha nhlobo ama-medication okunciphisa umzimba, iziguli zingase futhi zishicilele izinguquko zenqubomgomo ngokuxhumana nezingxenye ze-HR nokucela ukukhava kwe-GLP 1 esikhathini esilandelayo sokubhalisa. Izinhlangano ezifana neObesity Action Coalition zinikeza izincwadi ezibonelo nezinsiza ukusiza iziguli ukuthi zicele ukukhava kubaqashi noma kuma-insurer.

Izindlela Zokulondoloza Ngaphandle Kokukhava Okugcwele Komshwalense

Ngisho nangaphandle kokukhava komshwalense, kunezinketho. I-Eli Lilly ihlinzeka ngamaviyili e-Zepbound ngentengo ephansi ngeLillyDirect, etholakalayo kuyo yonke imigidi kungakhathaliseki isimo somshwalense - kufaka phakathi labo abase-Medicare noma i-Medicaid. Amanani aqala kusukela cishe ku-$299 ngenyanga kusidodo sokuqala.

Amapulatifomu esaphulelo afana neSingleCare neGoodRx angasiza ukunciphisa izindleko ekubambeni ekhemisi. Lezi zibalulekile ukuzibheka ngisho nalabo abanamshwalense, njengoba izindleko zangaphandle zingahluka phakathi kwamakhemisi.

Isiphetho

Ukuthola i-Zepbound ikhokhwa ngumshwalense kudinga umzamo, kodwa akukho okungenakwenzeka. Amaphilisi azimele ngokusebenzisa abaqashi ahlala eyindlela evame kakhulu, kodwa ukukhava kuyaqhubeka nokushintsha njengoba ama-insurer elungisa ama-formulary yawo. I-Medicare ne-Medicaid kancane kancane zandisa ukufinyelela, futhi izinhlelo zokulondoloza ezivela kumkhiqizi zisiza ukuvala isikhala.

Isinyathelo esibaluleke kakhulu ukubheka ngephirisi lomshwalense elithile - hhayi igama lomshwalense kuphela, kodwa imininingwane yangempela yephirisi. Kusukela lapho, ukusebenza nomhlinzeki wezempilo owazi kahle ukuhambisa ukugunyazwa kwangaphambili nezikhalazo kwenza umehluko omkhulu. Ezigulini ezifanelekayo, izinketho zosizo lwezezimali ezikhona namuhla zenza i-Zepbound ifinyeleleke kakhulu kuneyentengo ebonakala.

Isitatimende: Lokhu okuqukethwe kungokwezinhloso zolwazi kuphela futhi akumele kuthathwe njengeseluleko sezokwelapha noma somshwalense. Imininingwane yokukhava ishintsha njalo. Njalo qinisekisa ngqo nomhlinzeki womshwalense futhi uxhumane nochwepheshe wezempilo ofanelekayo ngaphambi kokwenza izinqumo zokwelapha.