If you're thinking about a weight loss medication, or you've already started one, you probably have questions. How does it work? Will it be covered? What happens after the first few months?
Starting in 2026, your NALC Health Benefit Plan pairs weight loss medication with something just as important: a free, personal care team through the CVS Weight Management Program. This guide covers how it works, what you need to do to stay covered, and what support you can count on along the way.
How GLP-1s work, and why support makes the difference
GLP-1 medications copy a hormone your body already makes. That hormone acts on the parts of the brain that control appetite, so many people feel full sooner and think about food less often. For a lot of members, that makes healthy changes feel possible for the first time.
Still, the medication is only one part of the picture. The National Institutes of Health notes that weight management medications "work best when combined with a lifestyle program". Research also shows what happens without that foundation. In one major study, people who stopped both their medication and their lifestyle program regained about two-thirds of the weight they had lost within a year (Wilding et al., 2022).
That's the thinking behind the program. Your medication helps with appetite, and your care team helps you build eating, movement and daily habits that can carry your progress forward.
Does this apply to me?
The program is required if you fill a medication that is FDA-approved for weight loss through your Plan’s pharmacy benefit. That includes members who were already taking one before 2026.
A few groups don’t need to enroll:
- Members taking a GLP-1 to treat diabetes. If your medication is FDA-approved for diabetes, such as Ozempic® or Mounjaro®, you don’t need to join.
- Members with Medicare Part D through SilverScript. You don’t need to enroll. Weight loss medications may still be covered with prior authorization, and your cost depends on the medication. Call Customer Service at 888-636-6252 for details on your prescription.
Your path to coverage, step by step
To have your weight loss medication covered at your Plan cost, you'll go through four steps. Most members finish the first three within a few weeks.
- Talk with your doctor. Your doctor will look at your health history, your goals and any other conditions to decide if a weight loss medication is right for you. Federal health guidance generally recommends these medications for adults with a BMI of 30 or higher, or 27 or higher with a related condition such as high blood pressure or type 2 diabetes (NIH).
- Get your medication approved. All prescription weight loss medications need approval from CVS Caremark before the Plan covers them. This is called prior authorization. Your doctor usually sends the request, but you can also call 800-294-5979 to start it, check its status or ask which medications are covered.
- Enroll in the CVS Weight Management Program. Once your approval is on file, call 800-207-2208 to enroll. You'll be asked to download the Health Optimizer™ app, which is where much of your program lives.
- Stay engaged, once a month. To keep your medication at your regular Plan cost, connect with your care team at least once every 30 days in one of these ways:
- Complete a phone or virtual visit with your care team, or
- Reply to a secure chat message from your care team
Already taking weight loss medication? You’ll still need to enroll. Once your current prior authorization expires or is updated, the Plan will only cover your medication at your regular cost if you’re enrolled and staying engaged. Enrolling now helps you avoid a gap.
What to expect once you join
The CVS Weight Management Program is built around you, not a one-size-fits-all diet. After you enroll, you'll be connected with a team of clinicians, including providers and registered dietitians, who work with you one on one. They'll help you set realistic goals and adjust your plan as your needs change.
Here's what's included, at no cost to you:
- A personal nutrition plan that fits your health needs and daily routine
- The Health Optimizer™ app, with recipes, guides and goal tracking
- A connected scale and other devices, as needed, so you and your team can see your progress over time
Many members find the extra accountability helps, especially early on, when adjusting to a new medication can bring side effects like nausea or an upset stomach. Your care team is a good place to bring those questions, along with your doctor.
Understanding your costs
The program itself is free. Your medication is covered under your regular prescription benefit, and your share depends on your plan, where you fill it and whether the drug is on the Plan's preferred drug list.
|
High Option |
CDHP |
|
|---|---|---|
|
Retail pharmacy, up to 30 days |
30% for preferred brands 50% for non-preferred brands |
30% for preferred brands 50% for non-preferred brands |
|
Mail order or Maintenance Choice, up to 90 days |
30%, up to $350 (preferred) 50%, up to $500 (non-preferred) |
30%, up to $450 (preferred) 50%, up to $650 (non-preferred) |
Percentages are of the Plan’s approved price. You’ll find the full details in Section 5(f) of your 2026 plan brochure.
Good to know: some weight loss medications and doses can be filled for more than 30 days, and the 90-day option caps what you pay per fill. But not every medication or dose comes in a 90-day supply, and not all are available by mail. Check with CVS Caremark at 800-294-5979 or your pharmacy to see what’s available for your prescription.
When life gets in the way
Weight loss isn’t a straight line, and neither is life. Shift changes, family needs and health setbacks happen. Here’s how the program handles a missed month:
- After 40 days without activity, you’ll get a reminder.
- If 30 more days pass without a visit or message, your Plan cost share ends and you’ll pay the full price of your medication.
Getting back on track is simple. Complete a visit or reply to a message from your care team. Your status will update, and you should be able to fill your medication at your Plan cost again within 1 to 3 days. If you’re not sure where you stand, call or chat with your care team at 800-207-2208, and they’ll walk you through it.
Other ways your Plan supports your weight goals
Medication isn't the right fit for everyone, and it's not the only support your Plan offers. Whether you're exploring options or want extra help alongside your prescription, these are available:
- Free weight counseling with in-network providers, including nutrition and behavior coaching
- Virtual nutrition visits through the NALCHBP Telehealth app
- Real Appeal® for High Option members: a free yearlong online program with group coaching, one-on-one support and a Success Kit with a food scale and portion plate. Get started with Real Appeal.
- Cigna Weight Management Program for CDHP members: personal coaching by phone or online through myCigna.com
You can explore everything in our guide to NALC HBP wellness programs.
Protect yourself: stick with FDA-approved medication
With so much demand for GLP-1s, you may see ads for cheaper versions online, often from websites that skip a real doctor visit. The FDA warns that compounded and other unapproved versions of semaglutide and tirzepatide aren’t reviewed for safety, quality or effectiveness, and it has received reports of people harmed by dosing errors (FDA). Your Plan covers FDA-approved medications filled at licensed pharmacies, so you know exactly what you’re taking.
Common questions
Which weight loss medications does my Plan cover?
Examples of medications that may be covered include Wegovy®, Zepbound®, Saxenda® and Foundayo®, along with other FDA-approved weight management medications. All of them require prior authorization. Coverage depends on the Plan’s formulary and clinical requirements. The formulary is reviewed every quarter, so new medications may not be added right away. For the latest on a specific medication, call CVS Caremark at 800-294-5979.
Are GLP-1 pills covered?
Yes, oral options such as Foundayo® and oral Wegovy® may be covered with prior authorization, just like injectable medications. You’ll also need to enroll in the CVS Weight Management Program.
I take Ozempic or Mounjaro for diabetes. Do I need to enroll?
No. The program is only required for medications FDA-approved for weight loss.
Can I join the program before my medication is approved?
Not yet. Your approval needs to be on file first. Once it is, a quick call to 800-207-2208 gets you started.
Is this the same as Real Appeal?
No. Real Appeal is a lifestyle program open to High Option members whether or not they take medication. The CVS Weight Management Program is specifically for members using weight loss medication, and it’s required to keep your Plan coverage.
Is the program changing in 2027?
Yes. Starting January 1, 2027, the CVS Weight Management Program will also support younger members of NALC HBP families.
We're here to help
Whatever stage you're at, you don't have to figure it out alone.
- Get your medication approved: CVS Caremark, 800-294-5979
- Join the program: CVS Weight Management, 800-207-2208
- Questions about your benefits: NALC HBP Customer Service, 888-636-6252
This article is for general information and isn't medical advice. Talk with your doctor about what's right for you. Your full benefits are in the 2026 plan brochure.
