Beginning January 1, 2027, GLP-1 medications for weight loss, including Zepbound, will no longer be covered under PPO Plans A and B.
The Joint Health Management Board (JHMB) understands that changes to prescription drug coverage can raise questions, especially for members who currently use these medications or are considering them as part of their healthcare.
We want to provide additional information about this decision, why the change is necessary, and what it means for members.
Why Is This Coverage Changing?
JHMB is committed to providing comprehensive healthcare benefits while managing rising prescription drug costs and protecting the long-term financial stability of your health plan.
Over the past year, JHMB has taken several steps to manage the increasing costs of GLP-1 medications prescribed for weight loss.
In July 2025, copays for these medications were increased to help reduce costs to the health plan. Additional changes followed in January 2026, including further copay increases and the exclusion of Wegovy and Saxenda from coverage.
Despite these efforts, spending on GLP-1 medications for weight loss is projected to reach $4 million in 2026, accounting for approximately 10% of the health plan’s total prescription drug spending.
These rising costs made additional changes necessary to avoid significantly higher copays on other medications that may be covered by your plan.
What Does This Mean for Members?
Effective January 1, 2027, GLP-1 medications prescribed for weight loss, including Zepbound, will be excluded from coverage under PPO Plans A and B.
Members who currently use Zepbound or are considering treatment with a GLP-1 medication for weight loss are encouraged to speak with their healthcare provider about their treatment options and how this coverage change may affect their care. This includes members that may be using or considering Zepbound for sleep apnea where body mass index is part of the FDA criteria for the medication.
JHMB’s Continued Commitment to Members
JHMB recognizes the importance of access to healthcare treatments and the impact that changes to prescription benefits can have on members.
The decision to exclude GLP-1 medications for weight loss was made after previous cost-management efforts proved insufficient to address the growing expense of these medications.
JHMB will continue to monitor medical indications for GLP-1 medications and evaluate potential adjustments to prescription benefits as needed to maintain the financial stability of the health fund.
Our goal remains to balance access to valuable healthcare benefits with the long-term sustainability of coverage for all members.
