Changes to weight loss drug coverage starting January 1, 2026

Starting January 1, 2026, Fallon Health’s Community Care plans will no longer cover medications used for weight loss.

This includes drugs used to:

  • Suppress appetite
  • Treat obesity or being overweight
  • Treat obesity-related health issues (such as Wegovy, which is used for both weight loss and cardiovascular disease and Zepbound which is used for both weight loss and obstructive sleep apnea)

All previously approved authorizations for medications used for weight loss will end effective Dec. 31, 2025. These medications will no longer be covered starting Jan. 1, 2026.

GLP-1 medications (like Ozempic and Mounjaro) will still be covered if they’re being used specifically to treat diagnosed type 2 diabetes.

List of drugs for weight loss that will not be covered as of Jan. 1, 2026*

  • ADIPEX-P CAP 37.5MG
  • ADIPEX-P TAB 37.5MG
  • BENZPHETAMIN TAB 50MG
  • CONTRAVE TAB 8-90MG
  • DIETHYLPROP TAB 25MG
  • DIETHYLPROP TAB 75MG ER
  • LOMAIRA TAB 8MG
  • ORLISTAT CAPS 120MG
  • PHENDIMETRAZ CAP 105MG ER
  • PHENDIMETRAZ TAB 35MG
  • PHENTERMINE CAP 15MG
  • PHENTERMINE CAP 30MG
  • PHENTERMINE CAP 37.5MG
  • PHENTERMINE TAB 37.5MG
  • QSYMIA CAP 11.25-69
  • QSYMIA CAP 15-92MG
  • QSYMIA CAP 3.75-23
  • QSYMIACAP 7.5-46MG
  • SAXENDA INJ 18MG/3ML
  • WEGOVY INJ 0.25MG
  • WEGOVY INJ 0.5MG
  • WEGOVY INJ 1.7MG
  • WEGOVY INJ 1MG
  • WEGOVY INJ 2.4MG
  • XENICAL CAP 120MG
  • ZEPBOUND INJ 10/0.5ML
  • ZEPBOUND INJ 12.5/0.5
  • ZEPBOUND INJ 15/0.5ML
  • ZEPBOUND INJ 2.5/0.5
  • ZEPBOUND INJ 5/0.5ML
  • ZEPBOUND INJ 7.5/0.5

Questions?

If you have questions or concerns about this change, please contact Customer Service at 1-800-868-5200 (TRS 711).

*  This list of drugs is subject to change.