A smarter way to manage GLP-1 coverage for weight management

GLP-1 demand continues to put employers in a tough spot: respond to growing interest in coverage or protect against rising long-term pharmacy costs. In response, Premera is shifting the decision from an all or nothing approach to a more strategic benefit design discussion.

New GLP-1 coverage options give you flexibility

As GLP‑1 use grows, you want options that better fit your business goals. We’ve created two new solutions that support your population needs, risk tolerance, and financial strategy. This structured model helps support clinically appropriate access, manage utilization, and improve cost predictability—without forcing employers into broad open coverage or a full exclusion.

Why it matters

GLP‑1 coverage decisions involve tradeoffs among cost, access, and outcomes. Choosing the right option starts with understanding your business priorities and balancing cost, member experience, and use.

Some options use tighter controls. Others offer more flexibility or broader access. More access can increase use. Tighter controls can help manage costs. These tradeoffs help frame coverage decisions.

Our new solutions

GLP-1 Access Select – Access Select manages cost while allowing coverage. It sets a BMI threshold of 35 for weight loss GLP‑1s. Members with a BMI of 27–34 must also have two related health conditions.

GLP-1 Clinical Select (medical indication only) – Clinical Select supports members who need GLP‑1s for medical reasons, not weight loss. It’s designed for groups that don’t cover weight loss GLP‑1s today. Coverage includes FDA‑approved conditions such as heart disease, sleep apnea, and MASH/NASH.

Optional lifestyle and behavioral support programs can still complement your business strategy, but are not required to access pharmacy benefits.

Contact your Premera account representative or producer for more information.