Important update regarding your weight loss medication coverage
We want to provide you with an update related to weight loss medications coverage. Starting January 1, 2025, weight loss medications continue to be covered but are no longer be included on the Highmark Preventive Drug List.
Highmark Blue Shield has made the decision across its book of business to remove weight loss medications, including GLP-1s, from the Preventive Drug List.
While some other insurers and employers have made the decision to discontinue coverage altogether, Highmark and Penn State continue to offer coverage for these medications based on our prescription plans’ benefit design. For Penn State, this change impacts your out-of-pocket cost depending on the medical plan in which an employee is enrolled. A letter from Highmark regarding this change was mailed to all members utilizing one of these medications in October 2024.
For example, for 2024, employees enrolled in the Lion Advantage HSA plan were NOT given deductible credit for these medications and the cost sharing was 20% of the Highmark allowed amount. For 2025, these medications WILL accumulate toward the deductible and the 20% coinsurance applies.
In 2024, employees enrolled in the Lion Traditional plan paid 20% coinsurance, but for 2025, will pay 50% coinsurance at the retail pharmacy for a 30-day supply.
Please note that you can continue to take this weight loss medication. Changes are shown in the chart below in underlined font.
Comparison of 2024 to 2025 Weight Loss Medication Insurance Amounts
| Medication | Lion Advantage Plan 2024 - On Preventive Drug List | Lion Advantage Plan 2025 - On National Select Formulary | Lion Traditional Plan 2024 - On Preventive Drug List | Lion Traditional Plan 2025 - On National Select Formulary |
| BENZPHETAMINE HCL DIETHYLPROPION HCL DIETHYLPROPION HCL ER PHENDIMETRAZINE TARTRATE PHENDIMETRAZINE TARTRATE ER PHENTERMINE HCL |
Does not count toward Deductible Generic 10% Coinsurance applies |
Will count toward Deductible Generic 10% Coinsurance applies |
Generic 10% Coinsurance applies |
Retail / UHS 30-day(1)(2) Generic 50% Coinsurance applies Mail Order/ UHS 90-day(3) Generic 20% Coinsurance applies |
| WEGOVY ZEPBOUND |
Does not count toward Deductible Preferred Brand 20% Coinsurance applies |
Will count toward Deductible Preferred Brand 20% Coinsurance applies |
Preferred Brand 20% Coinsurance applies |
Retail / UHS 30-day(1)(2) Preferred Brand 50% Coinsurance applies Mail Order / UHS 90-day(3) Preferred Brand 20% Coinsurance applies |
| ADIPEX-P CONTRAVE ER LOMAIRA ORLISTAT QSYMIA SAXENDA XENICAL |
Does not count toward Deductible Non-Preferred Brand 40% Coinsurance applies |
Will count toward Deductible Non-Preferred Brand 40% Coinsurance applies |
Non-Preferred Brand 40% Coinsurance applies | Non-Preferred Brand 70% Coinsurance applies |
(1) Retail – Limited to 30-day supply available at Express Scripts participating pharmacies and University Health Services (UHS) pharmacy.
(2) UHS – University Health Services pharmacy is located at the University Park campus available to all employees regardless of location offering 30- and 90-day supply of medications.
(3) Mail Order – Delivery option for 3-month supply
Financial assistance provided by drug manufacturers may be available to help reduce your out-of-pocket costs. To see if you may be eligible for financial assistance for a weight loss medication no longer on the Preventive Drug List, please refer to the below resources:
- The Zepbound Savings Card Program: visit https://zepbound.lilly.com/coverage-savings or call 1-800-LillyRx (1-800-545-5979)
- Wegovy Savings program: visit https://www.wegovy.com/coverage-and-savings/save-on-wegovy.html or call the Wegovy® Navigation Line at 1-833-4-WEGOVY
- Contrave Savings Coupon Card: visit https://contrave.com/enrollment/ or call 1-800-905-5576
- The Qsymia Savings Card: visit https://qsymia.com/patient/multiple-ways-to-save/savings-card or call 1-888-998-4887
Please note that you may have to re-enroll with a coupon card even if you used one last year. Please check the terms and conditions of your drug, as they may vary.
Comparison of 2024 to 2025 Weight Loss Medication Dollar Amounts
| Medication | Lion Advantage Plan 2024 - On Preventive Drug List | Lion Advantage Plan 2025 - On National Select Formulary | Lion Traditional Plan 2024 - On Preventive Drug List | Lion Traditional Plan 2025 - On National Select Formulary | Coupon Eligibility (as of January 2025 - please visit sites above for current offers) |
|
WEGOVY at Retail Cost: $1,285.74 |
$257.15 |
$1,285.74 (deductible) $257.15 (after deductible) |
$257.15 | $642.87 | As low as $0 with insurance (with limitations – see sites above for details) |
|
ZEPBOUND at Retail 2024 Cost: $1,010.24 2025 Cost: $1,035.49 |
$202.05 |
$1,035.49 (deductible) $207.10 (after deductible) |
$202.05 | $517.75 | As low as $25 with insurance (with limitations – see sites above for details) |
Manufacturer coupons or copay assistance programs are unable to be used with Express Scripts Mail Order Pharmacy. However, University Health Services (UHS) Pharmacy does allow use and can be a great option for employees by combining the mail order 90-day benefit lower coinsurance and the manufacturer discount programs. Employees can also utilize flexible spending account or health savings accounts funds to pay for these medications.
We felt it was important to continue coverage for this class of medications for 2025 to continue to evaluate the long-term success for our employees. We understand the change that Highmark had made to the Preventive Drug List is causing some frustration to our employees based on past usage, but we hope this helps clarify the intent and the methods for reducing cost as much as possible.