We're changing our GLP-1 coverage
We’ve made the decision to end coverage for GLP-1 medications, except for type 2 diabetes. This change will take effect upon your plan renewal, starting January 1, 2026.
This change may be difficult for those of you who’ve made real progress in your health and wellness journey using GLP-1s. We recognize the disruption this causes and are here to support you.
Why we're making this change
Ending GLP-1 coverage was a difficult, but necessary, decision.
The cost of GLP-1s are soaring and, as a not-for-profit organization, we’re unable to provide coverage without driving premiums and employer costs even higher. Continued coverage would also be unsustainable for our business.
We’ve approached GLP-1 manufacturers to advocate for lowering prices without success, but we continue to work toward making health care more affordable for everyone.
You may still have access to coverage through your employer.
If you have insurance through your employer, they may have the option to include GLP-1 coverage for weight loss. Your plan may also include other benefits to help you in your weight management journey.
We understand this change will greatly affect some of you. We’re committed to supporting you through this transition and helping you understand your options.
SUPPORT FOR WEIGHT LOSS AND WELLNESS
Your prescribing provider can help you determine the next step in your weight management journey. Whether you hope to continue taking GLP-1s for weight loss or want to know about other benefits you may have, we’re here to help you understand your options.
We know that many of you want to remain on your medication. Here are two ways to save when you pay out-of-pocket for GLP-1s:
- Many manufacturers offer savings programs, like copay cards, that can help lower your out-of-pocket costs. Visit the manufacturers’ websites to explore your options.
- Use funds from your tax-free health savings account (HSA), health reimbursement arrangement (HRA), or flexible spending account (FSA) to cover the cost. Learn more about these accounts.
There are other care options available to help you manage your weight and wellness.
- Talk to your provider for guidance on alternative medications.
- Use our Find a Doctor tool to find nutritionists, dietitians, and other providers who may be able to help.
- If you need to stop taking a GLP-1, you can talk to your provider about how to manage common side effects.
We know you may have tried all kinds of ways to manage your weight before finding success with GLP-1s. As a reminder, you still have access to a variety of weight-management benefits that have helped others:
- Use Team Blue Care Management to find guidance and support from registered nurses, mental health specialists, and more.
- Get reimbursed for eligible weight-loss programs, gym memberships, online workout subscriptions, and other fitness activities.
- Save up to 30% on holistic wellness offerings for your mind and body, like acupuncture, nutrition counseling, personal training, hypnosis, and more.
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.
Your current prior authorization will end when your plan renews, on or after January 1, 2026. At that time, your GLP-1 medication will no longer be covered under your plan.
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. 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 are based on 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.
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.