Coverage Updates and What to Know

We know that managing weight is deeply personal, and questions about medication coverage can feel frustrating or discouraging. While GLP-1 medications may support weight loss, coverage requirements may have changed for some plans.

Understanding GLP-1 Medications

GLP‑1 medications aren’t a quick fix, but for some people they may be one part of a broader plan developed with a provider.

GLP‑1 medications commonly prescribed for weight loss may work by:

• Helping you feel full sooner or longer
• Reducing appetite
• Supporting long-term weight management when combined with lifestyle changes

Your provider can help decide whether a GLP‑1 is appropriate for you based on your health history and goals.

A Focus on Long-term Health and Lasting Results

GLP-1 medications can be helpful tools for weight loss, and many people see the most lasting results when medication (if appropriate) is combined with nutrition guidance, physical activity, behavioral counseling, and ongoing follow-up care.

For this reason, MVP updated coverage requirements for GLP-1 medications used for weight loss to better support whole person care and long-term health outcomes.

Depending on your plan, GLP‑1 medications may not be covered for weight loss, or they may require additional steps (such as prior authorization or documentation showing participation in lifestyle supports). Your Provider can access the MVP Medical Policy for Weight Loss Medications for more information.

How Coverage is Determined:

Coverage for GLP 1 medications approved for weight loss depends on your MVP plan benefits. Some plans cover certain GLP-1 medications when specific medical criteria are met (such as prior authorization or diagnosis requirements). Other plans do not cover GLP-1 medications for weight loss at all (such as Vermont Commercial and Exchange plans, Medicare Advantage, and Child Health Plus plans). GLP-1 medications for weight loss may also be covered when used to treat other medically approved conditions, based on your plan benefits.

What Hasn’t Changed

It’s important to know that:

• GLP-1 medications continue to be covered when prescribed for other FDA-approved or medically accepted conditions, such as Type 2 diabetes, based on your plan benefits
• Existing approvals made before the policy change are honored through their approved timeframe
• If you disagree with a coverage decision, an appeal process may be available, and your provider can help support your request

If Cost is a Concern

If your plan does not cover GLP-1 medications for weight loss and cost is a concern, you still have options. You can explore using manufacturer savings programs, coupons, or using Health Savings Account (HSA) or Flexible Spending Account (FSA) funds to help lower out of pocket costs. Your provider or pharmacist can help you understand what options may be available and appropriate for you.

Encouraging a Comprehensive Approach to Weight Management

Coverage requirements reflect that weight management is most effective when it includes:

• Nutrition guidance
• Regular physical activity
• Behavioral or lifestyle counseling
• Ongoing follow‑up with a provider

Rather than requiring a specific or branded weight loss program, MVP looks for consistent and well‑documented participation in these types of supports for at least six months. This approach allows flexibility while still ensuring members receive comprehensive care.

Member Tip: If your plan includes a well-being reimbursement benefit, it can be used to pay for a weight-loss program membership (like Noom), but it cannot be used to pay for a GLP-1 drug.

Working with Your Provider

If a GLP‑1 medication is being considered for weight loss, your provider may:

• Review your health history and body mass index (BMI)
• Talk with you about lifestyle approaches you’ve already tried
• Discuss the benefits, risks, and expectations of weight loss medication
• Help submit any required documentation for coverage review

Some plans may require documentation that you’re participating in lifestyle supports (such as nutrition, physical activity, and behavioral coaching) for up to six months as part of coverage review and approval.

Next Steps: Understand Your Coverage

If you’re considering a GLP‑1 medication for weight loss, or you’ve been told your coverage may have changed, these steps can help you understand what applies to your plan:

• Review your plan benefits and Formulary for current coverage and requirements
• Ask your provider whether prior authorization or step therapy applies
• Talk with your provider about other covered options that may support your goals
• If available, ask about requesting an exception or filing an appeal
• For benefit questions or help with next steps, contact the MVP Member Services/Customer Care at the number on the back of your MVP member ID card or sign in to Gia® to send a secure message

Coverage varies by plan, so be sure to check your individual benefits.

Member Tip: To view your plan’s benefits and coverage information, sign in to Gia online and select My Plan, then My Benefits.*

*Excludes self-funded (ASO) plans. If you have a self-funded (ASO) plan, refer to your Summary Plan Description through your employer.

If a GLP-1 Medication Isn’t Covered

It can be discouraging to learn that a medication isn’t covered under your plan. If coverage is denied or not available for weight loss, start with the steps below to understand the reason and identify alternatives.

• Review the coverage decision with your provider to understand the reason and whether additional documentation could help
• Discuss other covered medications or treatment approaches that may meet your health needs
• Ask about covered programs or coaching resources that can support your goals, with or without medication
• If you want to pursue an exception or appeal, ask what documentation is needed and the best way to submit it

Your provider can help you think through next steps based on your health needs.