New Requirement for GLP-1 Medications

The following is intended for those Harvard Pilgrim subscribers who are currently using, or may use in the future, GLP-1 medications (particularly Zepbound and Wegovy).

In the November Open Enrollment communications we explained that, while many insurance companies and employers have chosen to no longer cover GLP-1 medications for weight loss, Boston College has elected to continue the coverage, but with the requirement that anyone using these medications in 2026 will need to participate in an Optum sponsored program called Calibrate.

The Calibrate program is intended to assist members in reaching their weight loss goals through personalized coaching and assistance with lifestyle changes. There is a monthly cost associated with each person who enrolls in the Calibrate program, and that cost will be fully paid by Boston College.

People currently using GLP-1 medications were sent a letter from Optum in late November stating that it will be necessary to enroll in the Calibrate program for coverage to continue. People will not be able to initiate enrollment until January, although the letter was not particularly clear on that point. But those currently using the medications will have 90 days, from January 1 to March 31, to complete enrollment, and during that 90-day grace period the medications can be refilled in the normal fashion. Once enrolled, however, the GLP-1 medication will need to be prescribed by a Calibrate physician for pick-up at your pharmacy or home delivery.

If someone doesn't enroll in Calibrate by April 1, 2026, the GLP-1 medication will no longer be covered by our plan.

The Open Enrollment communication also stated that, starting in 2026, the copay for GLP-1 medications will increase to $150. This copay will apply to all Wegovy and Zepbound prescriptions. However, it will not apply to the following drugs prescribed for diabetes treatment: Ozempic, Mounjaro, Rybelsus, Trulicity and Liraglutide. The normal copays will apply to those medications.

Starting January 1 you can contact Calibrate for enrollment at JoinCalibrate.com/edHEALTH or you can call the Calibrate support team now at 1-888-270-9366.

Program Summary and Eligibility