MedicaidCoverageHigh impact
Coverage of GLP-1s for Tufts Health RITogether members
Harvard Pilgrim Health Care·RI · Endocrinology, Bariatric Surgery, Internal Medicine +1 more·Provider Newsletter
Effective date
Oct 1, 2026
We identified it
Aug 13, 2026
Summary
Effective October 1, 2026, Tufts Health RITogether will no longer cover GLP-1 medications when prescribed for weight loss. All existing prior authorizations beyond this date will be terminated, and affected members will be notified. Billing teams must prepare to deny claims for weight loss indications and update authorization processes.
Action Required
By September 15, 2026: Billing team must update claim submission protocols to deny all GLP-1 medication claims (including but not limited to semaglutide, tirzepatide, liraglutide) for Tufts Health RITogether members when the primary indication is weight loss or obesity management. Update billing system to flag these claims for denial and generate member communication templates. Verify all active prior authorizations in the system and prepare to end-date those expiring after October 1, 2026. Notify clinical staff to document any medically necessary GLP-1 use for approved indications (e.g., type 2 diabetes, cardiovascular disease) separately to ensure proper coding. Beginning October 1, 2026: Reject all weight loss-indicated GLP-1 claims from Tufts RITogether members. Monitor for additional guidance from Rhode Island Executive Office of Health and Human Services and update procedures accordingly.