HMSA generally does not cover weight loss medication under its standard commercial plans, which explicitly exclude weight loss programs as a benefit. Coverage may be available in narrow circumstances: when a GLP-1 drug is prescribed for a different condition like type 2 diabetes, when a federal employee plan allows an anti-obesity drug through prior authorization, or, starting July 1, 2026, when a Medicare Advantage member qualifies for the new federal Medicare GLP-1 Bridge program.
What HMSA’s Standard Plans Exclude
Weight loss programs appear on the exclusions list across HMSA’s main plan types. The Platinum PPO Summary of Benefits and Coverage lists “Weight loss programs” among excluded services.1HMSA. Platinum PPO Summary of Benefits and Coverage Plans offered through Hawaii’s Employer-Union Health Benefits Trust Fund carry the same exclusion, with a qualifier that it applies “except as required by Health Reform Law.”2EUTF Hawaii. Summary of Benefits and Coverage EUTF Plan HMSA Federal Plan 87, which covers federal employees in Hawaii, excludes “weight loss programs not offered through HMSA.”3HMSA. Federal Plan 87 High Option Summary of Benefits and Coverage
A George Washington University review of HMSA coverage through the state employee plan found that anti-obesity drugs are generally not covered, though coverage is “possible with prior authorization.” That same review found behavioral therapy for weight reduction, along with related exams, labs, and supplies, is excluded regardless of medical necessity.4GW Stop Obesity Alliance. State Employee Obesity Coverage – Hawaii
When a GLP-1 Might Still Be Covered
The most-prescribed weight loss drugs today are GLP-1 receptor agonists: semaglutide (sold as Ozempic for diabetes and Wegovy for weight management) and tirzepatide (sold as Mounjaro for diabetes and Zepbound for weight management). The same molecule can be covered or excluded by HMSA depending on why it was prescribed.
When a GLP-1 is prescribed for type 2 diabetes or cardiovascular risk reduction rather than weight loss, it can fall under standard pharmacy benefits. HMSA formularies are organized by condition, and drugs categorized as diabetes or endocrine treatments follow different rules than those classified as anti-obesity agents.
HMSA also maintains a dedicated “Anti-Obesity Medication” policy on its provider resource center, though its terms apply to HMSA Federal Plan 87 and the Postal Service formulary.5HMSA. Anti-Obesity Medication For those federal employee plans, there is a defined route to anti-obesity drug coverage even though the general default is exclusion.
Medicare Advantage: New Coverage Starting July 2026
Federal law has historically barred Medicare Part D from paying for drugs prescribed specifically for weight loss, which applies to HMSA Akamai Advantage and other HMSA Medicare Advantage plans with drug coverage. That is changing on a limited basis.
Starting July 1, 2026, the Medicare GLP-1 Bridge program will provide access to certain GLP-1 medications for eligible Medicare beneficiaries, including those enrolled in Medicare Advantage plans with drug coverage. The program covers Wegovy (injection or tablet), Zepbound (KwikPen only), and Foundayo (tablet). The copay is $50 per one-month supply, and that amount does not count toward the Part D deductible or the out-of-pocket maximum.6Medicare.gov. Weight Loss Drugs
Eligibility depends on BMI and related conditions:
- BMI of 35 or higher: eligible without additional conditions.
- BMI 30 to 34.99: eligible with at least one qualifying condition, such as uncontrolled hypertension, chronic kidney disease (stage 3a or higher), prediabetes, diastolic heart failure, or a history of heart attack or stroke.
- BMI 27 to 29.99: eligible only with prediabetes, a history of heart attack or stroke, or symptomatic peripheral artery disease.
Beneficiaries who already receive a covered GLP-1 through their standard Part D plan, or who have type 2 diabetes, moderate-to-severe sleep apnea, or fatty liver disease, are not eligible for the Bridge program. Prescribers must submit a prior authorization certifying that the medication will be used alongside a lifestyle program focused on diet and exercise. Approved authorizations run through December 31, 2027.6Medicare.gov. Weight Loss Drugs
How To Check Your Plan and Ask for an Exception
HMSA offers many plan variations, so the reliable step is to check the specific plan document rather than rely on a general rule.
- Check Drug Cost tool: log in to My Account at hmsa.com, select “Drug Pricing,” and search by drug name and dosage to see whether it is covered, what it costs, and what restrictions apply.7HMSA. Check Drug Cost Tool
- Plan formulary: each HMSA plan has its own formulary. Members can find the right one by checking the drug code on their membership card and looking it up on the HMSA website.8HMSA. Your HMSA Drug Formulary List
- Phone: call HMSA at (808) 948-6000 or 1-800-660-4672.
If a medication is off the formulary or restricted, HMSA members can request an exception. The prescribing doctor submits a supporting statement explaining medical necessity. For Medicare plans, HMSA generally decides within 72 hours, or within 24 hours for expedited requests when a delay could harm the member.9HMSA. Akamai Advantage Dual Care Formulary Requests can be submitted through the pharmacy benefit manager at 1-855-479-3659 or online at hmsa.com/help-center/forms/medicare-drug-review/.
Commercial plan prior authorizations run through HMSA’s pharmacy benefit manager. Physicians can submit electronically through CoverMyMeds or by phone and fax, with separate lines for commercial plans (1-855-240-0543), QUEST Integration (1-855-220-5732), and Medicare (1-855-479-3659).10HMSA. HMSA Pharmacy Benefit Manager Prior Authorization A denial can be appealed.
If HMSA Won’t Cover It: Manufacturer Pricing
Drug makers offer direct-pay routes for members who can’t get coverage. Novo Nordisk’s NovoCare savings program offers Wegovy starting at $199 per month for new patients. Eli Lilly’s LillyDirect prices Zepbound between $299 and $499 per month depending on dosage. An oral Wegovy tablet launched in January 2026 with cash pricing starting at $149 per month, and a generic version of liraglutide (Saxenda) reached pharmacies in August 2025.