Information about changes to weight loss drug coverage in California

Coverage for GLP-1s and other anti-obesity drugs has changed. This information is intended to help you understand these changes and how they affect your coverage before you fill any new or existing prescriptions.

Who is this information for?

This information is for members in California who received a communication in December 2024 that said their coverage for GLP-1s and other anti-obesity drugs would change on January 1, 2025. If applicable, these changes were also stated in your Annual Notice of Coverage for 2025.

I heard the medications I use for weight loss will no longer be covered. What happened?

As part of our commitment to keeping the overall cost of care affordable, we regularly review our coverage and make adjustments. After careful review, we recently informed some Kaiser Permanente members in California of changes to their coverage for GLP-1s and other anti-obesity medications. 

Starting January 1, 2025, weight loss medications used only for losing weight will no longer be covered for members who have a BMI (body mass index) under 40. GLP-1s and other anti-obesity medications will continue to be covered for members with a BMI of 40 or above, as well as to help manage conditions like diabetes, peripheral artery disease, or a history of stroke or heart attack. 

What can I do if my plan no longer covers GLP-1s and other weight loss medications?

Your care team will work with you to explore alternatives to support your weight management goals. GLP-1 medications are one tool. But there may be other effective weight loss medications that are more affordable out-of-pocket than the drugs that are no longer covered. Your care team can also help enhance other areas of your weight management plan with a variety of resources, including:

  • Diet and exercise plans
  • Mental health and wellness resources
  • Self-care resources
  • Social health support
  • Classes and coaching

My BMI was over 40 when I was prescribed these medications, but now it’s under 40. Will I still have coverage for these medications? 

Members who started a weight management drug program overseen by their doctor when they had a BMI of 40 or above will still have access to these drugs for up to 24 months. And members whose BMI is still 40 or above after 24 months of treatment will continue to have access to these drugs. 

If my plan no longer covers the weight loss medication I was taking, can I pay for it myself?

Your doctor will continue to work with you to make key decisions about your care. However, if a prescribed medication isn’t covered by your plan, you can fill the prescription at a Kaiser Permanente pharmacy and pay the full cost of the medication. The cost will depend on which medication you’re prescribed. 

What will the full cost of my prescription be if the medication is no longer covered?

You can find out how much the medication will cost by calling the phone number listed on your prescription or by calling Member Services 24 hours a day, 7 days a week:

If I can’t afford the medication I’ve been prescribed, will my doctor help me find a more affordable option?

Our doctors make personalized treatment decisions in consultation with their patients. If you can’t afford a medication because of coverage limitations, your care team can work with you to identify other options to support your weight loss goals.

I’ve seen ads for online compounding pharmacies that offer GLP-1s. Do you recommend using these pharmacies?

No. Because of safety and quality concerns, Kaiser Permanente doesn’t recommend getting GLP-1s from outside compounding pharmacies.

For more information

If you have additional questions or want more information about these changes, please contact us at kp.org/supportcenter. To explore resources for maintaining a healthy weight, visit kp.org/weightmanagement.