GLP-1 for Weight Loss Coverage Change & Provider Q&A (September 2025)
Posted on September 5, 2025
GLP-1 for Weight Loss Coverage Change Effective January 1, 2026, and as employer groups/members renew their benefits throughout 2026, GLP-1 medications will no longer be covered for weight loss for Health New England Commercial plan members, unless their employer chooses to continue to cover them. Health New England will continue to cover GLP-1 medications for diabetes treatment that are FDA-approved for diabetes (Trulicity, Ozempic, Mounjaro, etc.). Medications that will no longer be covered include Saxenda®, Wegovy™ and Zepbound™.
- As of January 1, 2026, Health New England Individual and Small Group members will no longer have coverage for GLP-1 medications for weight loss.
- Coverage will end for members of Large Employer Groups with fewer than 100 actively enrolled subscribers on their 2026 renewal date.
- Large Employer Groups with 100 or more actively enrolled subscribers will have the option to continue coverage as part of their renewal for an additional cost through a rider.
- ASO (Self-Funded) Employer Groups will continue to have the option to cover or not.
Affected Health New England members will be notified in October of the 2026 coverage change.
Members of Commercial Large Group Plans will continue to have coverage until their 2026 renewal or beyond if their employer decides to purchase a rider for coverage.
The Prior Authorization process for these drugs will continue to be in place.
We will continue to publish information about this change and will add information to the Health New England website at healthnewengland.org/glp-1-coverage. Please see below for Q&As.
| GLP-1 for Weight Loss Coverage Change – Provider Q&As | 1. Which weight loss injections are affected by this change?
The following GLP-1 injections will no longer be covered for weight loss in 2026:
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| 2. Can I request an exception or appeal to have my patient covered?
No, we are not making exceptions and coverage cannot be appealed because these drugs will be an exclusion to the member’s coverage and not part of their covered benefits. We will only cover GLP-1s for weight loss if the member’s employer purchases a rider to continue coverage. |
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| 3. My patient has an approved authorization beyond their renewal date. Will they have a grace period?
No, their authorization will expire upon their plan’s renewal date. For example, if the member has an authorization in place until March 1, 2026, and their plan renews on January 1, 2026, their authorization will expire on January 1, 2026. |
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| 4. When will my patients experience this change?
It depends on when their health plan benefits renew. For many of our members, this change will happen on January 1, 2026. |
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| 5. Will I get a list of my patients who are affected?
Lists will be available of your patients who are affected. They will also receive a letter from Health New England alerting them to the change. |
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| 6. What will happen when a member still has coverage through a rider?
Members who will continue to have coverage will have to meet the clinical criteria and obtain prior authorization for the medication. |
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