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Weight-Loss Medication Coverage Update GLP-1 Review in Progress

Posted: May 29, 2025
Comments: 0
Author: Chad Pook
Blue Cross Blue Shield of Massachusetts (BCBSMA) has announced that, effective January 1, 2026, GLP-1 medication for weight loss will be excluded from the medical and prescription drug plan. This change is due to significant financial losses and increased utilization. Key details include:
  • Excluded weight-loss drugs: Wegovy®, Saxenda®, Zepbound®
  • Not affected: GLPs for type 2 diabetes (e.g., Ozempic®, Mounjaro®, Trulicity®) (prior authorization still required)
  • Optional coverage: The MBA Group Insurance Trust can "opt in" via a voluntary rider
  • No appeals: The rider is the only path to continue coverage for weight loss
  • Notice to members: BCBSMA will notify members and providers about 60 days before the change (e.g., by November 3, 2025)
What We're Doing
The Association is working with our Board of Trustees, benefits consultants, pharmacy benefit experts, and BCBSMA to evaluate the impact of these changes. We're conducting a thorough, data-driven review to ensure we make the best decision for your employees' well-being while ensuring that our healthcare plan benefits remain affordable.
What to Expect
  • Through December 31, 2025: Current coverage for weight-loss GLP-1s continues
  • Starting January 1, 2026: Claims for weight-loss use will be denied without a rider; diabetes use remains covered
  • In the meantime, we are working closely with BCBSMA to reduce disruption for members currently using these medications
Our Timeline
1. Analysis Phase (Now - July 2025)
  • Cost and clinical modeling
  • Benchmarking with peer plans
  • Rider pricing and operational planning
2. Preliminary Recommendations (by September 2025)
  • Evaluate rider cost and impact
  • Review plan design alternatives (e.g., copays, benefit structures)
  • Consider non-drug strategies to support weight loss
  • Consider expanding existing programs to include discounted out-of-pocket obesity medications
3. Final Decision (by September 2025)
  • Based on data and expert input
  • Ensuring a balance between affordability and access
We expect to receive the rider's cost in early summer. We’ll share updates in September and again before BCBSMA sends out its November 2025 member notices. If you have any questions, please contact Chad Pook, VP Group Insurance Trust Administration at cpook@massbankers.org or Tanya Duncan at tduncan@massbankers.org.

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