What you need to know
Two changes to Tier 1 and Tier 2 prescription drug coverage (offered through MedImpact) will take effect on August 1, 2026:
- Anti-obesity medications, such as GLP-1s prescribed for weight management, including Wegovy and Zepbound, will no longer be covered. However, the Fund will continue to cover generic phentermine for weight loss. You could pay less for certain GLP-1 weight-loss management medications, if they’re purchased directly through the manufacturer and/or other direct-to-consumer savings programs. If you take one of these medications, be sure to review Additional resources for anti-obesity drug savings for tips on finding potential cost savings.
- For certain specialty drugs (including drugs that treat autoimmune diseases, cancer, HIV, and other conditions that require ongoing care) to be covered, you must enroll in the MedImpact Assist Program.
Note: The fund will continue to cover GLP-1 prescriptions if you are being treated for diabetes.
The reason for these changes
These prescription drug changes are the most recent steps the Fund has taken to preserve our long-term financial stability in the wake of continued growth in prescription drug and other health care costs. GLP-1 drugs currently represent 11.5% (about $1.4 million) of the Fund’s prescription drug expenses, and specialty drugs account for more than 43.4% (more than $5.5 million)—and these numbers are growing each year.
Anti-obesity medication changes
What you need to know and do
If you’re currently taking an anti-obesity medication, such as Wegovy or Zepbound:
- You will pay 100% of the cost of those drugs beginning August 1.
- You can expect to receive a letter from our pharmacy benefit manager, MedImpact, explaining that the GLP-1 you take for weight loss will no longer be covered under the Plan beginning August 1. The letter will also provide a link to manufacturer discount information for your drug.
Some oral and injectable GLP-1s for weight loss may be available at a lower cost if purchased directly through the manufacturer or another direct-to-consumer website. You could pay less out of pocket than you do now when you use manufacturer discount programs, but be aware that these programs can change at any time.
For more information on manufacturer discount programs and other ways to save on the cost of your GLP-1 prescription, review Additional resources for anti-obesity drug savings below.
The Fund will continue to cover GLP-1 prescriptions if you are being treated for diabetes.
Additional resources for anti-obesity drug savings
If you and your doctor decide you should continue taking anti-obesity medications, including GLP-1s prescribed for weight loss, at your own expense, the resources below may help you cover the cost of your medication without Plan coverage.
Prescription discount cards
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Prescription discount cards are designed to provide lower drug costs to patients who pay for their medications out of pocket. These cards are available even if you have insurance. To use them, you simply download a mobile application (or access them online), search for your medication, show the coupon or discount at the pharmacy, and pay the discounted rate. Commonly known vendors for prescription discount cards are GoodRx and SingleCare. Both of these vendors offer discounts on GLP-1 medications at participating pharmacies.
Manufacturer savings programs
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Manufacturer savings programs are typically for expensive, brand-name medications, so they are a useful resource for minimizing costs for GLP-1 medications. The manufacturer may cover all or some of your costs. Generally, you can obtain a manufacturer copay card through the manufacturer’s website. For many of these programs, there is an expiration date and/or maximum savings limit, but these vary by medication. Some states have enacted legislation to limit the use of these programs, so you should ask your provider or pharmacist about the availability of manufacturer copay cards for your medication.
Manufacturers like Novo Nordisk (produces Wegovy, Ozempic, and Rybelsus) and Eli Lilly (produces Mounjaro and Zepbound) currently offer savings cards for their medications. You can research the manufacturer’s website online, and here are a few examples:
Other financial assistance programs
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Some pharmaceutical manufacturers, nonprofits, and foundations provide financial assistance to help patients afford medications when their insurance does not cover a specific drug. Each program has unique enrollment and qualification requirements. In many cases, there is an income threshold to qualify for such programs. Search online for patient assistance programs that currently cover the specific medication you need that may not be included in the MedImpact formulary—the medications that MedImpact covers—or ask your doctor for recommendations. Here are some organizations that currently provide patient assistance programs:
New specialty drug programs
MedImpact Assist Program
If you are currently prescribed a specialty drug that is included in the MedImpact Assist Program, you must enroll in this program.
Enrollment enables you and the Fund to share in reduced costs for these drugs. The program can help reduce out-of-pocket expenses for high-cost specialty drugs by tapping into assistance programs offered by drug manufacturers or charitable foundations. In some cases, your costs may be as low as $0 out of pocket. As a reminder, before you can fill prescriptions for these medications at a retail or mail-order pharmacy, you need approval from MedImpact as part of its prior authorization process.
You will have to enroll in the MedImpact Assist Program once every year. A MedImpact representative will contact you in January to enroll again for 2027 (and each January after that for subsequent years).
If you’ve filled a prescription for a medication included in the MedImpact Assist Program—either at a retail pharmacy or through MedImpact’s Birdi mail-order program—you will receive a letter from MedImpact, as well as a call from a MedImpact member advocate to begin enrollment in this mandatory copay assistance program.
Even if you’ve reached your current-year out-of-pocket maximum, you must enroll in the program, because any remaining manufacturer savings could be applied toward future fills. If you do not enroll, your pharmacy may reject your next prescription fill request, or you may be financially responsible for up to 100% of the cost.
Once you have received your letter from MedImpact, you can contact a representative at (866) 377-1255, Monday–Friday, 8 a.m.–8 p.m. ET, or Saturday, 9 a.m.–5:30 p.m. ET.
MedImpact Patient Assist Program
Depending on your financial circumstances, you could also be eligible for MedImpact’s Patient Assist Program, an optional savings program that can help reduce your prescription drug expenses for specialty medications covered under the MedImpact Assist Program. The MedImpact representative who contacts you about the MedImpact Assist Program will also talk to you about the Patient Assist Program.
Frequently asked questions about the MedImpact Assist Program
Here are answers to some of the questions you may have about MedImpact’s Assist Program.
What should I expect?
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If you have been prescribed a new specialty medicine, you may be required to use the MedImpact Assist Program. If your medication requires prior authorization, a MedImpact representative will reach out to help you enroll in the program.
If your medication does not need prior authorization and is part of the MedImpact Assist Program, your prescription will be flagged at the pharmacy, and you will need to call MedImpact at (866) 377-1255 right away. You will be assigned a representative who will advocate on your behalf, enroll you in the program, and start looking for ways to lower your medication costs.
To verify your qualification for certain optional and voluntary assistance programs, you may be asked to provide information, such as:
- Your household size
- The state you reside in
- Whether you are a U.S. citizen
- Your eligibility for federal health care benefits
Your MedImpact representative will keep your responses confidential. They will not be shared with the Plan or used to determine benefit or drug coverage.
How will I know if any of my medications are specialty drugs?
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Specialty drugs are high-cost prescription drugs that treat complex conditions, like autoimmune diseases, cancer, or other conditions requiring a medical specialist. They also may need special handling. If you don’t know if your medication is a specialty drug, you can ask your doctor, your insurance provider, or pharmacy, or call MedImpact at (866) 377-1255.
Will my medication be delayed?
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Your medication will not be delayed if you respond promptly to MedImpact notifications and requests for information. To avoid any delays, follow the program guidelines and communicate regularly with your dedicated MedImpact representative.
What if I don’t communicate with my MedImpact representative?
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Your MedImpact representative will make multiple attempts to reach you, including confirming your preferred and alternate contact methods (phone or email) with the Fund Office.
If you have not engaged with a MedImpact representative, you’ll be financially responsible for the entire cost of your specialty medication.
What if I do not qualify for a financial assistance program?
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If you don’t qualify for a manufacturer assistance program, and other alternative sourcing is not available, your medication will be covered based on your standard benefit and will be subject to any deductible, coinsurance, or copay until your maximum out-of-pocket limit is met.
Do I need to enroll if I already have an approved prior authorization, including for refills?
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Yes. This is a mandatory program for both new prescriptions and refills. Once you have an approved prior authorization, you do not need to go through that process again until it’s time to renew the prescription. If you have questions, call the MedImpact Service Center at (866) 377-1255, Monday–Friday, 8 a.m.–8 p.m. ET, or Saturday, 9 a.m.–5:30 p.m. ET.