Gain Greater Flexibility in GLP-1 Weight Management Coverage

Oct. 7, 2026

Applies to Self-Funded Groups*

Beginning Nov. 1, 2026, self-funded groups with Prime Therapeutics^® that cover GLP-1 weight-management drugs can elect a new, $150 member cost-share benefit. Self-funded employers can use this flexible benefit to help manage costs while preserving access to weight management coverage.

• Applies to injectable and oral formulations of either GLP-1 weight management drugs or traditional brand weight-loss drugs.
• Applies at all in-network retail and mail-order pharmacies.
• Can be used with or without weight management or weight loss prior authorization, a 30-day maximum supply limit or with KeepWell^™, a cardiometabolic health program.

The cost share benefit does not apply to GLP-1 drugs approved to treat diabetes, such as Ozempic, Mounjaro or Trulicity.

At a glance: Cost sharing is the same for all covered GLP-1 weight management drugs. Examples of weight-loss brand names include Foundayo, Saxenda, Wegovy and Zepbound.

• $150 cost share for a 0-30-day supply
• $300 cost share for a 31-60-day supply (if no 30-day max benefit)
• $450 cost share for a 61-90-day supply (if no 30-day max benefit)

Who is included:

• This applies to self-funded groups only.
• Fully insured groups and Cost Plus are not included.
• Non-ERISA self-funded groups will NOT be able to add this benefit due to pending legal reviews.
• In addition to Non-ERISA self-funded groups, IL ASO-HMO will not be able to add the benefit.

Why it matters: The new cost share could help manage pharmacy costs for self-funded employer groups. Plus, member payments count toward the deductible and out-of-pocket maximum. This data can improve care coordination between pharmacy benefits and medical benefits.

Talk to your Blue Cross and Blue Shield of Illinois account representative to learn more.

 

 

*This information will be shared with producers via News from the Blues and employer groups via Employer News.

Prime Therapeutics LLC is a separate company contracted by Blue Cross and Blue Shield of Illinois to provide pharmacy solutions. BCBSIL, as well as several independent Blue Cross and Blue Shield Plans, has an ownership interest in Prime Therapeutics.