We're changing our GLP-1 coverage
We’re sharing news about our coverage of these medications. While we remain committed to covering GLP-1 medications for type 2 diabetes, we’re changing our weight-loss coverage options.
We’re giving most employer customers the option to include coverage for GLP-1s for weight loss. These decisions will be made in the coming months, and coverage changes will take effect upon plan renewal, starting January 1, 2026.
Why we're making this change
Drug companies have priced GLP-1s incredibly high.
We know that for some of you, these medications have made a big difference in your weight-loss journey. Unfortunately, drug companies have priced GLP-1s so high that, at an average of $11,000 per person per year, they cost almost 10 times more in the U.S. than in other countries.
GLP-1s are driving premiums higher for everyone.
If we continue covering GLP-1s for the rising number of members who use them for weight loss, we expect it to cost nearly a billion dollars next year, up from $300 million in 2024. Because premiums are used to pay for coverage for all members, continuing GLP-1 coverage for weight loss would result in extremely steep increases in premiums for everyone — even those who don’t use GLP-1s.
The entire health care industry has been affected.
The bottom line is that GLP-1s are priced too high and many health insurance organizations have already discontinued coverage. As a not-for-profit organization, our first responsibility is to our members. We made this difficult decision so we can continue to cover all our members for care they may need and remain a sustainable organization.
Your top GLP-1 coverage questions
If you’re taking a GLP-1 to treat type 2 diabetes, your medication will still be covered.
If your company has more than 100 employees, your employer will have the option to continue coverage. If they decide to discontinue coverage and you’re taking a GLP-1 for weight loss, the change will go into effect when your plan renews in 2026. After that date, your authorization for the medication will expire and you’ll no longer have coverage. Employers will make their coverage decision in the coming months.
If your company has fewer than 100 employees or you’re a direct-pay member, you’re not eligible to continue coverage. If you’re taking a GLP-1 for weight loss, the change will go into effect when your plan renews in 2026. After that date, your authorization for the medication will expire and you’ll no longer have coverage.
If you’re taking a GLP-1 to treat type 2 diabetes, your medication will still be covered.
If your company has more than 100 employees, your employer will have the option to continue coverage, but those decisions will be made in the coming months. If your employer decides to discontinue coverage and you’re taking one of these medications, we plan to contact you directly no later than 60 days prior to your plan’s renewal date.
Coverage for GLP-1s approved to treat type 2 diabetes is not changing. This includes Ozempic, Mounjaro, Trulicity, and others. These medications will continue to require prior authorization, which includes a documented diagnosis of diabetes. These medications are not approved for weight loss.
If your company has more than 100 employees, your employer will have the option to continue coverage. If they choose not to, upon plan renewal starting January 1, 2026, Wegovy, Saxenda, and Zepbound will no longer be covered, even if you’re currently using them.
No. This is a benefit exclusion that can’t be appealed.
Yes! We have a variety of weight-loss support options for those who’ve been diagnosed with obesity or want to lose weight, including:
- Lifestyle management programs that offer clinically proven support for weight management, nutrition, stress management, and more
- Support from our Team Blue Member Service Advocates and Care Managers who can help you stay on track with your health goals, answer questions in between appointments, coordinate care with your providers, and guide you to helpful resources and additional support
- Mental health and nutritional counseling with both virtual and in-person care options
- Reimbursements for fitness center fees, gym memberships, yoga/Pilates/tai chi class fees, weight-management programs, and more
- Discounts and deals on nutrition, fitness equipment, and more
- Bariatric surgery for members with health risks from being obese
Sign in to MyBlue to see other benefits you may have for weight-loss support.
The cost depends on several factors, including which GLP-1 medication you take. Some cost less than others, so check with your doctor or pharmacist about pricing. Additionally:
- Patient assistance programs and pharmacy discount services/platforms can help lower costs.
- Some pharmaceutical manufacturers provide cost assistance through patient assistance programs or prescription savings cards to help cover part of the drug cost. You can get that information from the manufacturer websites.
- If you have a health savings account (HSA) and/or flexible spending account (FSA), you may be able to use these funds to help pay for your medication.
No, your premium won’t go down. Premiums generally increase year-over-year due to a variety of factors, including the prices of hospital and provider services, use of inpatient and outpatient services, an aging population, the increased cost of prescription medications overall, and innovations in health care technology. We’re making this change to prevent excessive increases in premiums and ensure we’re able to cover all our members for care they may need.
Yes. If the cost of GLP-1s go down, we’ll revaluate what coverage would mean for our members and our organization. We’ll keep you updated if this happens.
While GLP-1s may eventually reduce the high costs associated with obesity, recent studies show that at the current price, these medications are far from being cost effective.
If you’re taking a GLP-1 to treat type 2 diabetes, your medication will still be covered.
If you have a Medicare Advantage Prescription Drug plan or a stand-alone Part D prescription drug plan, you will still not be covered for GLP-1s for weight loss, as these plans follow the Centers for Medicare and Medicaid Services guidelines.
If you have an individual Medex plan with embedded Part D prescription drug coverage, you’ll no longer have coverage for GLP-1s for weight-loss starting in 2026. The change will go into effect when your plan renews in 2026. After that date, if you’re taking a GLP-1 for weight loss, your authorization for the medication will expire and you’ll no longer have coverage.
If you have a group Medex plan through a previous employer, they may have the option to continue coverage. If they decide to discontinue coverage, the change will go into effect when your plan renews in 2026. After that date, if you’re taking a GLP-1 for weight loss, your authorization for the medication will expire and you’ll no longer have coverage. Our employer customers will make their coverage decision in the coming months.
Questions? We're here.
If you depend on GLP-1s, we know this might be a difficult time. If you have more questions or want to know about other benefits you may have to help you manage your weight, Team Blue Member Service advocates are here for you.
To talk to a Member Service advocate, call the number on your member ID card.
Support for weight loss and wellness
We know that for many of you, achieving a healthy weight is a priority. Depending on your plan, you may have other benefits to help you manage your weight and support you in nourishing both body and mind, such as:
Personalized nutrition guidance
Work with a dietitian to make choices that support and enhance your health goals.
Holistic health solutions
Try options like Pilates and acupuncture to nurture your mind, body, and spirit.
Fitness & weight-loss reimbursements
Get reimbursed for gym memberships, weight-loss programs, and more.
Sign in to MyBlue to view your benefits, find personalized care options, and more.