Does Highmark cover GLP-1s?

What Highmark Inc. (Highmark Blue Cross Blue Shield / Highmark Blue Shield; Highmark Wholecare) says on its own pages (highmark.com), sorted by topic. Your own plan documents decide what you get.

Read Sep 28, 2026. Each line names the plan type it applies to.

Does it depend on your employer or plan?

In an August 30, 2024 bulletin, Highmark said it was revising its prior authorization policy for certain weight-loss drugs for fully insured commercial and ACA members.Employer and commercial plans:Highmark is revising its pharmacy prior authorization policy for certain weight loss medications for fully insured* commercial and Affordable Care Act (ACA) members.providers.highmark.com, Sep 28, 2026
The same August 2024 bulletin said prior authorization criteria for Highmark’s commercial self-insured members were not affected.Employer and commercial plans:Prior authorization criteria for weight loss medications for Highmark’s commercial self-insured members is not impacted.providers.highmark.com, Sep 28, 2026

Prior authorization criteria

Under the policy in Highmark’s August 2024 bulletin (fully insured commercial and ACA plans), adults starting or staying on Saxenda, Wegovy or Zepbound needed a baseline BMI of 40 or more and at least two weight-related conditions.Employer and commercial plans:For Saxenda, Wegovy, and Zepbound for initiation and maintenance in adults, requiring age of 18 years or older, use for chronic weight management, baseline BMI ≥ 40 kg/m2, at least two weight-related comorbiditiesproviders.highmark.com, Sep 28, 2026
In that 2024 policy, Saxenda or Wegovy also required intolerance of, or a contraindication to, the plan-preferred Zepbound, and staying on treatment required weight loss of at least 7.5% from baseline.Employer and commercial plans:and if the request is for Saxenda or Wegovy, intolerance/contraindication to plan-preferred Zepbound. Additionally for maintenance, weight loss of ≥ 7.5% from baseline and maintenance dosing.providers.highmark.com, Sep 28, 2026
In that 2024 policy, starting any of the listed drugs required documented healthy diet changes and more physical activity for at least 6 months before starting and while on treatment.Employer and commercial plans:For all agents for initiation, requiring baseline height, weight, and BMI; and documentation of healthy dietary changes and increased physical activity for at least 6 months prior to initiation and while using therapy.providers.highmark.com, Sep 28, 2026

Type 2 diabetes

Highmark’s August 2024 bulletin said the weight-loss policy change did not affect FDA-approved GLP-1s used to treat type 2 diabetes.Employer and commercial plans:This policy change also does not affect FDA-approved GLP-1s used in the treatment of type 2 diabetes.providers.highmark.com, Sep 28, 2026

Recent changes

Highmark provider news (published Jul 7, 2026) says CMS’s Medicare GLP-1 Bridge for people with Medicare Part D starts July 1, 2026 and runs through Dec. 31, 2027.Medicare:The Centers for Medicare and Medicaid Services (CMS) is expanding access to certain GLP-1 medications for people with Medicare Part D through Medicare GLP-1 Bridge starting July 1, 2026. The program will continue through Dec. 31, 2027.providers.highmark.com, Sep 29, 2026
Highmark says the Medicare GLP-1 Bridge runs outside Medicare Part D plan coverage, with a central processor handling prior authorization, claims and pharmacy payment.Medicare:Medicare GLP-1 Bridge will operate outside of Medicare Part D plan coverage and use a central processor to manage prior authorization, claims processing, and pharmacy payment.providers.highmark.com, Sep 29, 2026
Highmark states the Bridge is a CMS-managed program and that Highmark is only sharing the information.Medicare:NOTE: This is a CMS-managed program. Highmark is sharing this information as a service to our members and our provider community.providers.highmark.com, Sep 29, 2026
Per Highmark’s Bridge notice, the drugs available under the Bridge are Foundayo tablets, Wegovy (injection and tablets) and Zepbound KwikPen.Medicare:What GLP-1 Drugs will be available for the Bridge Program? Foundayo® (tablets), Wegovy® (injection and tablets), and Zepbound® (KwikPen® injection).providers.highmark.com, Sep 29, 2026
Per Highmark’s Bridge notice, pharmacies collect a $50 copay for a 30-day supply under the Bridge.Medicare:What is the member cost for a 30-day supply of the selected GLP-1? Pharmacies will collect a $50 copay amount from the eligible beneficiary, and the central processor will process payment to the pharmacy.providers.highmark.com, Sep 29, 2026
Highmark Wholecare (Pennsylvania Medicaid plan) news item published Jan. 21, 2026 points providers to a Pennsylvania DHS bulletin about coverage and benefit changes for GLP-1s used for overweight/obesity for Medical Assistance beneficiaries; the page itself does not state what the change is.Medicaid (PA):Highmark Wholecare encourages providers to review the Pennsylvania Department of Human Services Bulletin regarding coverage and benefit changes for glucagon-like peptide-1 (GLP-1) receptor agonists for the treatment of overweight and obesity for Medical Assistance beneficiaries.providers.highmark.com, Sep 29, 2026
Highmark says that beginning Jan. 1, 2026 it offers the Noom weight management program at no additional cost to eligible members 18 and older (a digital program, not a drug benefit).Beginning Jan. 1, 2026, Highmark will offer the Noom: Weight Management Solution at no additional cost to eligible members aged 18 and older.providers.highmark.com, Sep 29, 2026
Highmark says Noom does not prescribe medications or manage GLP-1 prescriptions; it only offers a GLP-1 companion component for members already on these drugs.While Noom won’t prescribe medications or manage GLP-1 prescriptions, it includes a GLP-1 companion component for members already on these medications, offering educational content and support.providers.highmark.com, Sep 29, 2026
Highmark’s employer page says the Noom solution launched January 1, 2026 for almost 2 million commercial plan members.Employer and commercial plans:We launched this new solution on January 1,2026, with availability for almost 2 million commercial plan members.highmark.com, Sep 29, 2026

How to check your own plan

Highmark (Blue Cross Blue Shield member page) says the formulary lists the drugs a plan covers and drugs not on it are not covered.All plans:A formulary is the list of generic and brand-name prescription drugs covered by your plan. Drugs that do not appear on the formulary are not covered.highmark.com, Sep 29, 2026
Highmark says Individual/Family ACA and ICHRA members’ covered drugs are listed in the Essential Formulary.Individual (ACA) plans:If you have an Individual or Family ACA plan—whether you purchased it directly from Highmark, through a state or federal marketplace, or through an Individual Coverage Health Reimbursement Arrangement (ICHRA)—your covered prescription drugs are listed in the Essential Formulary.highmark.com, Sep 29, 2026
Highmark’s member formulary page gives a Member Service phone number for prescription-policy questions.All plans:If you have questions on the prescription policy or any of your benefits, contact Member Service at 1-800-241-5704 (TTY 711), Monday – Friday, 8 a.m. – 8 p.m.highmark.com, Sep 29, 2026
Highmark says members can find coverage and formulary details and estimate drug costs on the member website.All plans:Find coverage and formulary details, check copays and estimate drug costs for your plan on your member website.highmark.com, Sep 29, 2026

What we could not confirm

No web page from Highmark that we could read covers: does it cover glp-1s for weight loss; sleep apnea (zepbound); heart risk (wegovy).
More detail, such as exact BMI cutoffs, is in 8 PDF documents from Highmark, which we have not opened.