Provider Central

As we begin notifying members about our change in GLP-1 coverage, we’d like to remind prescribers about this benefit change and provide additional resources to support conversations with your patients—our members.

• GLP-1 medications will only be covered for type 2 diabetes starting on January 1, 2026 and as members renew their benefits throughout 2026.
• This exclusion from our pharmacy benefit means the member will no longer have coverage for GLP-1s for weight loss—even if we’ve covered the medication in the past or it’s been authorized. Previous authorizations will expire on the member’s effective date for this change.
• Benefit excluded medications are: Saxenda (liraglutide injection), Wegovy, and Zepbound. These medications are also excluded from coverage for other FDA-approved conditions, such as sleep apnea or heart disease.
• The only exception to this change will be for members whose employer purchases a rider to continue coverage. (Authorization will continue to be required.)

Resources

• Prescriber fact sheet: Includes information to support conversations with your patients (our members) 
• Affected member letter: Members are being notified approximately 60 days prior to their health plan anniversary date
• May 29, 2025 news article with answers to frequently asked questions: GLP-1 medications for obesity: Coverage update

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