​Effective January 1, 2025, Independence Blue Cross (IBX) will no longer offer coverage for drugs —including glucagon-like peptide-1 receptor antagonist (GLP-1) and non-glucagon-like peptide-1 receptor antagonist (non-GLP-1) — indicated for and prescribed solely for weight loss in the ​absence of other FDA-approved clinical indications. This change is part of standard benefits for our fully insured group and individual Commercial members.

Please note: Medicare does not allow drug coverage for Part D-excluded use, such as weight loss. Medicare will allow coverage for Wegovy® when prescribed for the cardiovascular indication.

IBX will continue to provide coverage for GLP-1 drugs prescribed to your patients (our members) for FDA-approved medical conditions and indications, including type 2 diabetes and cardiovascular disease, with prior authorization.

What this means for members

Patients with IBX plans who are currently taking a GLP-1 or non-GLP-1 drug for weight loss and want to continue taking the medication will be responsible for the full cost of the drug beginning January 1, 2025, or when their coverage plan renews.

Impacted members may be able to use their Health Savings Account (HSA) or Flexible Spending Arrangement (FSA) dollars, if eligible. Starting November 2024, members will be receiving a letter by mail notifying them of the upcoming changes.

Why this benefit change is happening

This decision was not made lightly and was focused on the immediate needs of all our members. We took several factors into consideration, including the responsibility we have to our members to provide the best value of health care coverage. This includes balancing drug coverage with associated increases in premiums to pay for the drugs.

Higher premiums affect all members, whether they receive weight loss drugs or not. The cost of these drugs in the United States is almost 10 times more than in other parts of the world. These exorbitant costs have made it extremely challenging to be able to continue to provide drug coverage to everyone who wants these drugs but does not have an FDA-approved medical condition or indication for these drugs.

This is a change that several leading health plans have already made, which highlights how widely spread and universal this problem is. 

Helping members on their weight management journey

Obesity is a complex chronic condition that is caused by several different factors. IBX believes that the cornerstone of healthy living and any weight management journey includes lifestyle changes such as diet, exercise, and behavioral modifications.

That's why IBX offers several benefits* to help members on their weight management journey that include:

• Outpatient nutrition and behavioral health counseling

• Reimbursements for fitness center fees, weight management programs, and other health-related programs

• Lifestyle management programs that offer clinically proven support for weight management, nutrition, stress relief, and more

• Bariatric surgery for members with health risks from being obese

Members should visit the IBX member site to review the different benefits that may be available to them.

For more information on pharmacy coverage and guidelines, visit IBX.

*Coverage of the listed services depends on the member's health plan. It also depends on if the member meets the medical necessity criteria outlined in IBX's pharmacy and medical policies.