News  June Update on Vida Health Program and GLP-1 Coverage

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.

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.