Mounjaro Tier 6 @ $2 copay on Wellcare Value Script but prior approval

[yorkriver1]

What could go wrong with prior approval?
My client technically can afford the drug but looking for the best situation.

 

[straightnochaser]

Shouldn't be an issue unless they don't have an active Type 2 Diabetes diagnoses

 

[Chazm]

This has nothing to do with your questions but I called into WellCare today with a client. The second time in the last 2 months and before that I hadn't called in years.

They picked up within 30 seconds and she was American. I asked for Claims and she transferred me over and the next American person picked up immediately. 100% smooth call for the second time in a row.
They have really come a long way.

That said, I have clients taking Mounjaro with WellCare and they've had no issues.

 

[yorkriver1]

This has nothing to do with your questions but I called into WellCare today with a client. The second time in the last 2 months and before that I hadn't called in years.

They picked up within 30 seconds and she was American. I asked for Claims and she transferred me over and the next American person picked up immediately. 100% smooth call for the second time in a row.
They have really come a long way.

In my state, Wellcare $0 premium PDP for 2024, Mounjaro, being diabetes adjacent has a $2 copay, at least before the gap, pretty nice, but heightened A1C may/may not be there to a level some internal metric may require. Clients like to think there is pre-diabetes and some say, no, it's just a degree of seriousness beyond a certain A1c. I am not a big student of this.
re: Wellcare now. Their star ratings must mean something. Good to know. And yes more organized it seems.
That said, I have clients taking Mounjaro with WellCare and they've had no issues.[/QUOTE]
Well, if I understand the Medicare Rx protocol, it's a up to a 90 day fill while waiting for a prior approval acceptance/rejection. If the person is already prescribed and taking the drug, which the person is doing.