Effective August 1, 2026, GLP-1 medications prescribed for weight loss will no longer be covered through CVS Caremark. Members who continue taking these medications will need to purchase them as cash-pay prescriptions and may be able to reduce their out-of-pocket costs by using available manufacturer coupons.
Please note that prescriptions for GLP-1 medications for weight loss will continue to be limited to providers at the Wellness Clinic.
Members enrolled in the Surest health plan are eligible for a GLP-1 Health Reimbursement Account (HRA) to help offset the cost of weight loss medications. Through this program, Larimer County will reimburse eligible members up to $200 per month.
Here's how it works:
The GLP-1 HRA is administered by Rocky Mountain Reserve (RMR). Additional information, including instructions for setting up your account and submitting reimbursement requests, will be provided as we get closer to the August 1 implementation date.
Because this change is taking effect mid-year and members are not able to change health plans until Open Enrollment, Larimer County will provide eligible High Deductible Health Plan (HDHP) members with an additional $200 per month contribution to their Surency Health Savings Account (HSA) through December 31, 2026. This temporary contribution is intended to help offset the cost of purchasing GLP-1 medications.
Beginning January 1, 2027, this temporary HSA contribution will end. Instead, eligible HDHP members will have access to a Health Reimbursement Account (HRA) benefit after meeting their annual deductible.
This change will be highlighted during Open Enrollment so members can consider this benefit when selecting the health plan that best meets their needs for 2027.
Additional information about the Rocky Mountain Reserve (RMR) Health Reimbursement Account (HRA) will be available soon.
Larimer County will offer access to Omada, a virtual weight management program designed to provide personalized support for members taking GLP-1 medications. Omada is available as an additional resource for those who would like extra coaching and guidance beyond the care they receive through the Wellness Clinic.
The program includes personalized support to help members build healthy, sustainable habits while continuing their weight management journey.
More information about Omada, including eligibility and enrollment details, will be available soon.
The County's self-funded health plan can no longer sustain the rising cost of covering GLP-1 medications for weight loss. In 2026, the estimated cost to provide coverage for approximately 150 members is $2.4 million, which is more than the $1.9 million it costs to operate the Wellness Clinic.
Because the County pays health care claims directly, these increasing costs place significant pressure on the health plan's financial reserves. After carefully reviewing the long-term impact, County leadership and Department Heads determined that continuing coverage for these medications is not financially sustainable.
Cash pay (also called self-pay) means you pay the pharmacy directly for your medication instead of using your insurance benefits. Because the prescription is not billed through your health plan, the amount you pay does not count toward your annual deductible or out-of-pocket maximum.
No. This is not a qualifying life event, so you cannot change or drop your medical plan mid-year. You will have the opportunity to make changes during Open Enrollment, with any changes becoming effective January 1, 2027.
Manufacturer savings programs vary depending on the medication you are taking. The following resources are a good place to start:
Important: Beginning with your first prescription fill on or after August 1, 2026, let your pharmacy know that your medication is no longer being billed through your insurance and that you will be paying the cash price. Present any manufacturer savings card or coupon you plan to use at the time of purchase. After purchasing your medication, submit your receipt and proof of payment to the County's HRA administrator for reimbursement (up to $200 per month, if eligible).
No. You are not required to continue taking Wegovy. If you are interested in exploring other GLP-1 medication options, work directly with your provider at the Wellness Clinic to determine the best treatment plan for you.
Because these medications will no longer be covered through CVS Caremark for weight loss, you are no longer limited to a specific GLP-1 medication. Your provider can discuss available treatment options based on your individual needs.
Yes. Eligibility for these County benefits is determined through the Wellness Clinic. To qualify for the Surest HRA reimbursement or the temporary HDHP HSA contribution, you must continue participating in the Wellness Clinic's GLP-1 program.
You may participate in both the GLP-1 Health Reimbursement Account (HRA) and a Healthcare Flexible Spending Account (FSA) at the same time. However, IRS rules do not allow you to change your FSA election mid-year because of this benefit change.
If you are currently contributing the annual IRS maximum to your Health Savings Account (HSA), the Benefits Team will work with you to ensure you do not exceed the annual contribution limit after the County's temporary HSA contribution is added.
If an adjustment to your employee contribution is needed, the Benefits Team will contact you directly with next steps.
This change applies only to GLP-1 medications prescribed for weight loss.
If you are taking a GLP-1 medication for another clinically approved diagnosis, such as diabetes, obstructive sleep apnea, metabolic dysfunction-associated steatohepatitis (MASH) or heart disease, your medication will continue to be covered through CVS Caremark, provided the appropriate prior authorization requirements are met.
The clinically approved criteria for heart disease are a history of the following (high blood pressure unfortunately doesn't qualify):
If needed, the Wellness Clinic will work with you to ensure the required documentation is in place so you can continue filling your prescription without interruption.
Please contact the Benefits Team at hr_benefits@larimer.org.
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PHONE: (970) 498-5970 | FAX: (970) 498-5980
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