As we announced in last month’s issue of Insights and Updates for Providers, Point32Health is making changes related to coverage of GLP-1 weight management medications, as part of our efforts to provide access to the most appropriate health care options while managing health care costs.
Effective July 1, 2025 for members of our Commercial large group, Massachusetts merged market, and Tufts Health Direct plans (Value, Premium, Core Massachusetts, Tufts Health Direct, and Harvard Pilgrim ConnectorCare formularies), Zepbound will be designated as the preferred GLP-1 drug for the treatment of overweight and obesity in members 18 years of age and older.
With this update to our preferred product strategy, the medications Wegovy and Saxenda will be moved to non-formulary for the treatment of overweight or obesity in adults. As a result:
- Members who are 18 and older and currently receiving Wegovy or Saxenda for the treatment of obesity or overweight will be required to switch to Zepbound.
- Prior authorizations for Wegovy and Saxenda will be end dated for June 30, 2025. Prescribers will need to issue a new prescription for Zepbound for these members if continued treatment of obesity or overweight is needed.
Please refer to the initial April 2025 article for more information, including details about notable exceptions to these coverage changes, transitioning members to Zepbound, and requesting non-formulary exceptions.