Coverage Alert for GLP-1 Medications

06-May 2025 - SWSCHP's financial stability was at the root of a recent decision, effective July 1, 2025, to end coverage for GLP-1 medications that are used solely for weight loss.

As of the start of the new plan year on July 1, these drugs will only be covered for medically diagnosed Type 2 diabetes. This change aligns with FDA approvals, as GLP-1 medications are not approved for treating Type 1 diabetes or solely for weight management.

Currently, about 2% of our membership use these medications for weight management. This decision follows careful consideration by our healthcare and pharmacy benefits experts, who determined that continuing coverage of these medications for weight management could jeopardize the financial stability of our health plan and potentially impact coverage for other essential medical benefits. If a member is currently using GLP-1 medications for weight management, please discuss alternative treatment options with your healthcare provider.

If you want to view the SWSCHP pharmacy benefits, please log in to your account at Caremark.com (CVS). To speak to a Customer Care team member, you can call 844-260-5889.