Weight Loss Medications Will Be Reclassified as Lifestyle Drugs, Requiring a Higher Co-Payment, Effective October 1, 2024
The DGA-Producer Health Plan is the only health plan in the entertainment industry to cover weight loss drugs. Certain weight loss drugs, known as GLP-1s, are highly effective but availability is limited, and these medications are also very expensive. GLP-1s—commonly sold under names like semaglutide, Ozempic, Rybelsus, Wegovy, Zepbound, etc.—mimic the hormone that helps regulate blood sugar and promotes weight loss.
Recently, to ensure that those who are taking weight loss drugs are receiving support on their weight loss journey—even when no longer taking these medications—the Health Plan has introduced a new weight management program called Flyte. Effective July 1, 2024, any medications prescribed for weight loss for participants ages 18 and older will be covered only if you are enrolled in Flyte and the drugs are prescribed by a Flyte physician.
As part of the Health Plan’s ongoing efforts to manage the costs and maintain coverage of these GLP-1 medications, effective October 1, 2024, all weight loss medications, including GLP-1 medications prescribed solely for weight loss (both on and off-label), will be reclassified to the Health Plan’s Lifestyle Drugs co-payment tier, resulting in a higher co-payment. GLP-1 medications prescribed solely for diabetes are not Lifestyle Drugs and will continue to have the same brand co-payment of $24 for a 30-day supply or $60 for a 90-day supply. The chart below outlines the co-payment amounts for Lifestyle Drugs.
| Lifestyle Tier Co-Payments* | |
|---|---|
| Up to 30-day supplies | Up to 90-day supplies |
| Greater of $40 or 50% of the cost of the medication | Greater of $60 or 50% of the cost of the medication |
To help lower some of the prescription co-payment, certain manufacturer’s coupons and savings card programs may be available for weight loss medications. For a list of these discount savings, visit www.dgaplans.org/saveonweightloss.
For more information on Lifestyle Drugs, refer to the March 2020 Health Plan Summary Plan Description and its updates, which are available online at www.dgaplans.org/health-plan-booklet, or you may contact the Health Plan for a copy to be mailed to you at no cost. For more information about the Health Plan’s prescription drug benefits, visit www.dgaplans.org/prescription-benefits-overview.
