- 1,745
What could go wrong with prior approval?
My client technically can afford the drug but looking for the best situation.
My client technically can afford the drug but looking for the best situation.
Mounjaro Tier 6 @ $2 copay on Wellcare Value Script but prior approval
- Thread starter yorkriver1
- Start date
straightnochaser
Guru
- 549
Shouldn't be an issue unless they don't have an active Type 2 Diabetes diagnoses
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.
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.
- Thread starter
- #4
- 1,745
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.
