GLP-1 MEDICATIONS FOR WEIGHT LOSS

EXCLUSION EFFECTIVE JANUARY 1, 2027

Due to the rising cost of health care, MoKan has made the difficult decision to exclude GLP-1 Medications for weight loss effective January 1, 2027.

Some important facts about this determination:

1. This action was not taken lightly. Much like you manage your household or business budget, the Board of Trustees reviews the Plan’s financial information regularly and must take action to protect Plan assets when cost trends rise beyond what is reasonable. This is an extremely complex process that is evaluated with the help of consultants, actuaries, accountants, legal counsel, and other industry professionals.
2. Fewest Impacted participants with greatest saving to Plan: This change impacts the fewest number of participants, while saving the Plan the greatest amount compared to other Plan benefit change options. The overall goal is to provide the most benefits to the most participants, while ensuring the Plan has enough money to cover future expenses.
3. While the cost to the Plan for this medication is staying high, the cost of paying out-of-pocket is going down: The cost of purchasing GLP-1s directly from the manufacturer is going down. Currently, manufacturers are charging health plans as much as three times the price for the same medication as they charge individuals who self-pay. The Plan can be charged as much as $1,500 per month for these medications. This is not sustainable.
4. Alternative Options: Instead of discontinuing treatment, consider the following options that are not part of Plan coverage:

a. Direct From Manufacturer Savings Programs - Many pharmaceutical companies offer savings cards or discount programs that can significantly reduce out-of-pocket costs, even without insurance coverage.

1. Wegovy® may be obtained directly from the manufacturer (Novo Nordisk). � visit www.wegovy.com to learn more.
2. Zepbound® may also be obtained directly from the manufacturer (Eli Lilly). Your healthcare provider can send the prescription to LillyDirect® (https://www.lilly.com/lilly_direct/medicines/zepbound), and the prescription will then be delivered to your home.
3. For other weight loss medications, often times your healthcare provider may prescribe the generic and you can utilize a coupon card, like GoodRx, to reduce your out-of-pocket expense outside of insurance.

 b. Third Party Telehealth Services — Some telehealth providers specialize in weight management and may offer lower-cost access to medications, coaching, and lifestyle support. For example, WeightWatchers provides integrated care and access to weight loss medications, along with other programs available in the market.

2. Lifestyle and Wellness Resources Through MoKan — Your health plan includes various lifestyle and wellness resources, such as coverage for nutritional counseling from a registered dietitian.