Update on GLP-1 Medications

Earlier this year, the SWSCHP Executive Committee voted to discontinue coverage of GLP-1s prescribed solely for weight loss, effective July 1, 2025. Based on guidance from the New York State Department of Financial Services, this decision has been modified. Coverage for GLP-1s for weight loss will continue through the current plan year, which ends on June 30, 2026.

If you are currently prescribed a GLP-1, please check with your doctor to confirm your authorization status. Coverage remains subject to continuation-of-therapy criteria (such as age, BMI, weight-loss progress, and physical activity, among other drug-specific requirements). Your provider can help determine whether you meet these criteria and what documentation is needed.

Beginning July 1, 2026, the criteria for coverage of GLP-1s for weight loss could be modified, reduced, or possibly eliminated. Any proposed changes will be communicated well in advance to help members make informed decisions about their healthcare.

We understand that medication coverage decisions can impact your health and well-being, and we are committed to keeping you informed with clarity and timeliness. If you have questions, please contact CVS Caremark for assistance.To speak to a Customer Care team member, you can call 844-260-5889.