What You Need To Know About Obtaining Zepbound or Other GLP-1 Weight Loss Medications
We understand that PPO Plan A and Plan B members may need clarification about accessing GLP-1 weight loss medications. We’re here to outline exactly what’s covered, the prior authorization (PA) requirements, and how to properly use the MedImpact and Birdi workflow.
If you’re considering or currently taking Zepbound or another GLP-1 medication for weight loss, here’s what you need to know.
What’s Covered
As of January 1, 2026, the only covered GLP-1 medication for weight loss is:
Zepbound
Coverage requirements:
- Must be filled through Birdi mail order
- Limited to a 30-day supply
- $200 copay
- Prior authorization (PA) required
These rules are in place to help preserve access as the cost of GLP-1 medications has increased significantly.
Prior Authorization (PA) Requirements
For New Therapy
To begin Zepbound, prior authorization is required. In most cases, this requires:
- A Body Mass Index (BMI) of 30 or greater
MedImpact will send the required PA forms directly to your healthcare provider.
For Continuing Therapy
If you are already on Zepbound:
- A renewal PA is required at 29 weeks
- After that, PAs are required every 12 months
- You must generally demonstrate a 5% reduction in weight from your baseline
Important Clarification for Members Switching from Another GLP-1
If you are continuing therapy on a GLP-1 weight loss medication other than Zepbound, such as Wegovy: even if your BMI is now below 30, if you have lost 5% or more of your baseline weight, you may still meet prior authorization criteria for Zepbound under continuation-of-therapy guidelines.
Some members have reported concerns about losing weight successfully on Wegovy and then not meeting criteria to begin Zepbound. However, continuation-of-therapy rules generally allow members who meet the 5% weight-loss benchmark to continue treatment.
If you are unsure whether you qualify, speak with your provider and confirm that continuation-of-therapy criteria are included in your PA submission.
How to Access the MedImpact Portal
Birdi still fulfills prescriptions for PPO Plans A and B—but you must access Birdi through the MedImpact portal or mobile app.
You can not use Birdi.com directly.
Register or Log In at MedImpact
Visit: www.medimpact.com
Or download the MedImpact mobile app.
Important registration tips:
- Use your MedImpact member ID (found on your ID card)
- It is recommended that you register as a new member
- If you try to use an old Elixir login without address/phone on file, you may receive an error
- If you experience issues, call: (833) 640-2849 (number on your ID card)
Obtain Your Prescription
Most prescriptions are sent electronically (e-prescribed).
- E-prescriptions typically appear in the MedImpact portal within 24–48 hours
- You can track both your prescription status and prior authorization progress in the portal
Do not attempt to use the discontinued Birdi portal.
Request Mail Order Through the Portal
Once logged in:
- Go to “View All” under prescriptions
- Select “Request a Prescription” if it’s a new order
- If you are refilling, select your existing prescription
If you have never used Birdi before, you may be prompted to enter:
- Shipping address
- Medical information
- Payment information
If you experience issues updating your Birdi profile, contact Birdi directly at (866) 909-5170.
Ensure Your Prescription Is Submitted Correctly
To avoid delays, you may want to share the following information with your prescriber:
- NPI #:1639310600
- NCPDP #: 2372528
- Prescriber Line: 877-269-1159
- Prescriber Fax: 877-395-4836
- Address: P.O. Box 8004, Novi, MI 48376
You may also show them the information in the image below:
Start With MedImpact
Remember: even though Birdi fulfills the prescription, you must begin through MedImpact.com or the MedImpact app.
If you are experiencing registration or access issues, call the dedicated help desk line at (833) 640-2849.
Your prescription benefits are designed to work for you. Following the correct workflow will help avoid delays and ensure continued access to your medication.
For additional health benefit resources, visit:
www.jhmbhealthconnect.com
