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Harvard Pilgrim Health CareCommercial · Coverage · Pharmacy · MA, NH, ME, RI · Endocrinology, Family Medicine, Internal Medicine +2 moreHigh impact

Reminder: weight loss medication coverage update

Effective date
Jan 1, 2026
Identified
Jun 20, 2026

Summary

Harvard Pilgrim and Tufts Health Direct are significantly restricting weight loss medication coverage effective January 1, 2026. Most formularies will exclude all weight loss drugs including GLP-1 medications, with new prior authorization requirements and a mandatory 6-month behavior modification program for remaining covered plans.

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What to do

Action · 5 steps
01Before January 1, 2026: Billing team must update prior authorization workflows for weight loss medications on Harvard Pilgrim and Tufts Health Direct plans.
02Verify patient formulary type (Core, Select, ConnectorCare exclude coverage; Value and Premium may maintain coverage).
03For patients with existing approvals, notify that authorizations will terminate January 1, 2026 with no grandfathering.
04Update systems to require ResetStrong behavior modification program completion for new GLP-1 weight loss prescriptions on covered formularies.
05Claims will be denied without proper authorization after effective date.

Original notice

Reminder: weight loss medication coverage update
point32health.org · Always check the source before changing claims.
View original ↗

Related changes

See all Harvard Pilgrim Health Care changes →
Update on coverage of weight loss medicationHighEffective Jan 1, 2026 · PharmacyUpdate on coverage of weight loss medicationHighEffective Jan 1, 2026 · PharmacyReminder: weight loss medication coverage updateHighEffective Jan 1, 2026 · PharmacyBrowse every Harvard Pilgrim Health Care change in the policy list

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