Hello, AFSPA members,
It’s been more than a week since I provided an update on the EncircleRx program for members taking GLP-1 drugs for weight loss – either Wegovy or Zepbound. I want to apologize once again to all the members who have been impacted by the problems with implementing this program.
I have remained in daily contact with both Express Scripts and Teladoc regarding their progress in addressing the underlying issues that have led to the widespread problems. We are seeing improvements, but there is more work to be done.
Some members have had trouble registering for either the Teladoc Health Advanced Weight Management Program or the Teladoc Health Advanced Prediabetes program. For those, I will note that these programs appear in the Teladoc app under the heading of “FSBP.’ They likely appear separate from the telehealth services listed under the heading of “American Foreign Service Protective Association.” Members may need to toggle between these offerings while we work toward integrating them.
The most often cited issue is Express Scripts not having a record of a member’s Teladoc enrollment due to file communication issues between our two partners. To alleviate the impact of this issue on members, I temporarily authorized Express Scripts to allow providers to complete the required updated prior authorization for these drugs. Your provider can do so through the EviCore online portal or by calling 800-417-1764. This must be completed by your prescriber; it cannot be completed by the member or patient.
I will also note that the prior authorization requires documentation to show that the patient receiving the drugs met the following conditions at baseline, prior to starting the therapy:
As I mentioned before, documentation is required for the prior authorization to be completed and may show as pending until your provider submits that documentation.
My colleagues here at AFSPA and I will continue to work on this issue. I will provide an update by the end of next week. In the meantime, I encourage members to work with their provider for the necessary prior authorization and to continue to enroll and engage in the Teladoc programs.
Thank you for your continued patience as we work to ensure this program works as promised. We remain committed to providing the best possible service to our members and holding our partners to the same standard in line with our theme for this year: Better Tools: Better Health.
Thank you,
Kyle Longton, CEO
