Weight Loss Prescription Coverage Requires Enrollment in the Health Plan’s New Weight Management Benefits Provider, Flyte Medical, Effective July 1, 2024
Beginning July 1, 2024, due to the significant costs of the new classes of weight loss drugs and to ensure continuing support to sustain weight loss, any medications prescribed for weight loss on or after July 1, 2024 for participants and dependents ages 18 and older will only be covered if you are enrolled in the Health Plan’s new weight management benefits through Flyte Medical (“Flyte”), a medically supervised weight management program, and they are prescribed by a Flyte physician. If you are prescribed any of these drugs for treatment other than weight loss, the Health Plan will continue to cover your prescription as before, and you are not required to enroll in Flyte.
Flyte connects eligible participants and dependents to a team of physicians, nurse practitioners and registered dietitians. These experts create a personalized treatment plan to help you manage your weight, as well as any related health conditions such as diabetes, heart disease, sleep apnea, and liver disease.
Flyte is available to all eligible participants and dependents over the age of 18, regardless of whether a weight loss drug is currently being prescribed. Participants who are under 18 years of age are ineligible for Flyte and are allowed to continue treatment from non-Flyte providers. Weight loss medications will continue to be subject to Health Plan rules and prior authorization from CVS Caremark.
Changes to Weight Loss Prescription Coverage
Flyte’s treatment plan includes medications prescribed for weight loss, when clinically appropriate.
If you are currently taking medications prescribed for weight loss by a non-Flyte provider, the Health Plan continued to cover these prescriptions until July 31, 2024. After this date, your medications will no longer be covered unless prescribed by a Flyte provider. You will be notified by mail and email with instructions on how to start the Flyte enrollment process.
To start enrolling into the program, visit https://www.joinflyte.com/dgaplans and click Get Started.
Why the Change?
As the only health plan in the entertainment industry covering weight loss drugs, the Health Plan has seen a significant overall increase in the cost of covering these drugs, with that trend expected to continue for the foreseeable future. Over the past year, the Health Plan has seen increased utilization and interest in the new class of weight loss drugs called GLP-1s—available under brand names like Ozempic, Rybelsus, Wegovy and Saxenda. Through its partnership with Flyte, the Health Plan will be better positioned to manage access to these weight management medications so that it can continue covering them when clinically appropriate. Most importantly, Flyte’s weight management program is intended to help you through your weight loss journey and provide you the essential tools to sustain weight loss and a path toward better health.
What’s Covered Under Weight Management Benefits?
Flyte offers a variety of program services, including:
- Weight loss medications;
- Nutritional coaching with a registered dietitian;
- Goal setting and regular feedback on your progress;
- Weight tracking using a scale provided by and automatically connected to Flyte;
- Blood pressure tracking device provided by and automatically connected to Flyte;
- Four virtual visits with your Flyte provider/nurse practitioner, and three visits with your registered dietitian within a consecutive 12-month period; and
- Educational courses related to health and weight management.
What Does This Program Cost Me?
The services described above, excluding medications, are free to those who enroll and not subject to co-payments or co-insurance. However, prescription drugs prescribed by Flyte physicians are subject to the Health Plan’s normal prescription co-payments. (See Important Note on Health Plan Change on page 10 for changes coming October 1, 2024.) Additional visits with the Flyte care team beyond the seven allotted visits—unless approved by a Flyte provider—are subject to pre-authorization by the Health Plan. If additional visits are not pre-authorized, you will be responsible for the following per visit fee schedule: $250 for a physician visit, $213 for the nurse practitioner and $100 for the registered dietitian.
Who Qualifies for Flyte?
To qualify for the Flyte program, you must:
- Be a covered DGA-Producer Health Plan participant or dependent ages 18 and older;
- Be physically located within the United States; and
- Have a BMI of 30* or higher; or have a BMI of 27 or higher AND a weight-related health condition* (such as diabetes, sleep apnea, cardiovascular disease, or liver disease).
To learn more about weight management benefits through Flyte or to learn more about how to start the enrollment process, visit the Health Plan’s Weight Management Benefits Overview webpage at www.dgaplans.org/weightmanagement.
* Even if your current BMI does not meet the program eligibility criteria, Flyte may consider your historical BMI or past weight-related condition in determining eligibility. You are encouraged to submit the complete eligibility questionnaire by going to https://www.joinflyte.com/dgaplans and clicking Get Started.
