catch-22 in the formulary for Ozempic

[JohnT922759]

Recently, I was moved from 1 mg per week of Ozempic to 2 mg per week.

That should have been simply getting the 2 mg dose pen.  However, due to the popularity of the drug, it is having availability issues.  In particular, the 2mg dose pen is on back order with no estimate of becoming available.

My pharmacy substituted the 1mg dose pen and I did two injections. No problem.

When I went to refill the prescription, it was denied as "too early to refill".  

Other the last two weeks I have found the reason for that denial.  In the formulary, if look at the Ozempic entries you will see 'QL', quantity limits.  Going farther down you see the limits detailed.  I've edited the entries to make them clearer.

Ozempic (0.25MG/DOSE or 0.5MG/DOSE) (2MG/1.5ML Pen-Injector) B Maximum of 1 pen (1.5 ml) per 28 days

Ozempic (1MG/DOSE) (4MG/3ML Pen-Injector) B Maximum of 1 pen (3 ml) per 28 days

Ozempic (2MG/DOSE) (8MG/3ML Pen-Injector) B Maximum of 1 pen (3 ml) per 28 days

All of the above are 1 pen per 28 days.  That is fine is your weekly dosage matches the pen dose.  

In my case, I can not get the 2 mg dose pen.  I can only get the 1 mg dose pens.  So, I can't get the full 2 mg dosage coverage I have been prescribed.

I have talked several times with my doctor's office, the pharmacy and the UHC/Optum RX operations.  A Pre Authorization (PA) process is available to somehow fix this situation.  I am not sure where the ball stopped and wil be calling agin on Monday.

I am writing this for others to understand what is happening when they hit this or similar situations and that somehow this issue gets pushed up to the appropriate people within AARP that can work this issue with UHC.