Changes to GIC Coverage of GLP-1s for State Members

The Group Insurance Commission (GIC) is making a change to how certain weight loss medicines are covered. This includes medicines like Wegovy, Zepbound, and Saxenda. These are commonly used for weight loss.

Quick Summary

• Weight loss GLP-1 medicines will not be covered starting July 1, 2026.

• Some members may still qualify based on medical conditions.

• Diabetes medicines are not impacted.

• Vida will continue to offer weight management support, but will no longer prescribe anti-obesity medicines, including GLP-1.

What is changing?

Starting July 1, 2026:

• Medicines used only for weight loss will no longer be covered by your pharmacy benefit.

• Will GLP-1 medicines still be covered?

  Yes, in some situations.

Coverage may be approved if:

• You have certain medical conditions, and

• Your doctor submits a request showing the medicine is being used to treat that condition.

Examples of qualifying conditions include:

• Heart (cardiovascular) disease

• Sleep apnea

• Certain liver conditions (MASH/NASH)

If the medicine is prescribed only for weight loss, it will not be covered.

What if I take a GLP-1 medicine for diabetes?

Good news, no change for you.

• Medicines used for diabetes (like Ozempic or Mounjaro) remain covered.

• You do not need to enroll in any special program.

• Coverage will continue as it does today.

How is coverage to GLP-1 medicines changing starting July 1, 2026?

Here’s what to expect (if your prescription is for weight loss only):

• It will not be covered.

• You will need to pay the full cost out of pocket.

If your prescription is for weight loss plus an FDA qualifying medical condition*:

• Your doctor can request coverage.

• The request will be reviewed before a decision is made.

  
  

*The current list of FDA qualifying medical conditions (as of June 17, 2026) is below and subject to change at any time. If you have questions about your specific situation, please contact your provider or if you have questions about your coverage, contact CVS Caremark : 

• Non cirrhotic MASH/NASH with moderate to advanced (F2–F3) fibrosis 

  • No BMI requirement since this indication was FDA-approved in both overweight/obese and non-overweight populations 

• Risk Reduction of Major Adverse Cardiovascular Events in adults with established cardiovascular disease and obesity or overweight 

  • Requires a baseline BMI ≥ 27 kg/m² 

  • This is defined as a previous heart attack, previous stroke, symptomatic peripheral arterial disease, or prior history of a revascularization procedure 

• Treatment of moderate to severe obstructive sleep apnea in adults with obesity 

  • Requires a current BMI ≥ 30 kg/m² 

What is Vida Health, and what do the changes to GLP-1 coverage for obesity mean for me?

Vida is a program that provides:

• Health coaching

• Nutrition support

• Lifestyle guidance

  
  

Before July 1, 2026:

• Vida was part of how members accessed weight loss medicines. 

  
  

After July 1, 2026:

• You will no longer be able to schedule visits w/ Vida Physician/Nurse Practitioners.

• Vida will no longer prescribe anti-obesity medicines,including GLP-1s.

• Vida will continue to provide weight management support services only.

• Vida will direct you to your current non-Vida prescriber or, if you don’t have a current physician, the GIC network directory.

  
  

This means:

• Vida cannot approve or prescribe GLP-1 medicines.

• Medicine coverage decisions are handled through your pharmacy benefit.

• What if I’m not eligible for the Vida Health program? Some members are not eligible for Vida, including those with:

  • Diabetes

  • Certain complex medical conditions

    
    

If this applies to you:

• You can continue working with your regular doctor regardless of Vida eligibility.

• Your provider can still request medicine coverage if appropriate.

  
  

What should I do next if I am or will begin taking a GLP-1 medicine?

If you are currently taking a GLP-1 medicine:

• Step 1: Talk to your PCP or specialist outside of Vida - Ask if your medicine is being used for a condition that may qualify for coverage.

• Step 2: Confirm your coverage - Your doctor can submit a request if needed.

• Step 3: Ask questions if you’re unsure.

  
  

Still have questions?

We understand this is a change and want to make sure you have clear next steps.

• If you have questions about your prescription or coverage -> contact CVS Caremark at (877) 876-7214 or https://www.caremark.com/about-us/contact-us.html.

• If you have questions about the Vida program -> contact Vida support at (888) 688 7188 or support@vida.com.