As Kaiser Permanente continues to evaluate how we cover medications for weight loss, members in California will see changes for coverage of GLP-1 drugs and other Anti-Obesity Medications (AOMs) beginning January 1, 2025.
As a result of these changes, some members may lose coverage for GLP-1’s or other AOMs currently prescribed for weight loss purposes.
Kaiser Permanente will begin outreach to impacted members beginning November 21, 2024. This timing ensures that we’re accurately reaching out only to impacted members who are losing coverage in 2025. We’ll provide these members with details about the coverage change and information about our comprehensive approach to weight management and resources available for members through our weight management content on kp.org.
Clinicians are aware of the change in coverage and the optional weight loss drug rider for large commercial groups. Pharmacy teams are trained to have cost conversations with members should they get a prescription that is not covered under their plan.
Our core plans include comprehensive weight management, which may include medical weight management, tailored to each individual patient based upon their medical history and comorbidities. Effective with contract renewal on or after January 1, 2025, coverage for GLP-1 drugs and other AOMs will be removed from base coverage in California commercial and Individual & Family plans when those drugs are prescribed solely for the purpose of weight loss for patients with BMI less than 40.
Per California Title 28 Rule 1300.67.24(e)(3), GLP-1 drugs and other AOMs will still be covered under the base plan for patients with BMI equal to or greater than 40. Coverage remains unchanged for GLP-1’s and other AOMs, when prescribed as part of a disease management program for medical conditions (for example, Type 2 Diabetes or Major Adverse Cardiac Event).
Broader coverage for GLP-1s and other AOMs for patients without comorbidities or increased disease risk that are prescribed solely for the purpose of weight loss can be made available through purchase of an additional weight loss drug rider by large group plan sponsors.
Share these resources with members to provide information about what’s changing with weight loss medication coverage in 2025 and what resources Kaiser Permanente offers for weight management.
Your weight loss medication coverage (PDF)
Use this to share information with members about upcoming changes to GLP-1 and Anti-Obesity Medication coverage starting in 2025.
A holistic approach to weight management (with GLP-1 coverage) (PDF)
Use this to share information about Kaiser Permanente’s approach to weight management if the plan sponsor has purchased the weight loss medication rider covering GLP-1 drugs and other AOMs.
A holistic approach to weight management (without GLP-1) coverage (PDF)
Use this to share information about Kaiser Permanente’s approach to weight management if there is no coverage for GLP-1 drugs or AOMs from the plan sponsor.
For more information, or to discuss adding a weight loss medication rider for Large Group employers, please contact your account representative.
