Health Net: Important Updates for Large Group Weight Loss Medication Coverage
Starting with 2026 Large Group renewals, Health Net will implement a change to its standard pharmacy benefit for weight loss drugs. Coverage will be available to members with Class III severe obesity, defined as a body mass index (BMI) of 40 or higher.*
For clients who would like broader access, Health Net will offer a pharmacy rider. The rider provides expanded weight loss medication coverage beyond the standard benefit for members with a BMI of 30 or higher.
For more information, you can access these resources available in our Large Group Broker Portal:
* Prior authorization will be required. Members are required to enroll in a in a prescriber-recommended or Health Net-approved weight loss program weight loss program, prior to and concurrently while receiving the prescription weight loss drug. Members who are already receiving coverage for GLP-1s or other weight loss medications for obesity (BMI of 30 or higher), will continue to have these drugs covered, as long as their provider continues prescribing them for obesity.