November 21, 2025

Effective January 1, 2026, the Department of Human Services (DHS) is making a change to the Medical Assistance prescription drug benefit. This change applies to all Pennsylvania Medicaid plans, including Health Partners Plans Medicaid.

What is Changing?

Drugs containing a GLP-1 receptor agonist for the treatment of overweight or obesity will no longer be covered unless the member also has a condition for which a GLP-1 receptor agonist remains a covered prescription drug benefit.

Impacted GLP-1 medications include:

This change is authorized by 62 P.S. § 443.6(g), as amended by Act 2011-22, and 55 Pa. Code § 1121.54.

Action Required

Coverage for GLP-1 drugs currently authorized for overweight or obesity will end December 31, 2025.

If your patient is taking a GLP-1 drug for a condition other than overweight or obesity, a new prior authorization request may be needed to determine eligibility for continued coverage starting January 1, 2026.

The complete 2026 Statewide Preferred Drug List and prior authorization clinical guidelines will be posted prior to January 1, 2026 at papdl.com.

For the most up-to-date information regarding Health Partners Plans formularies, please visit our online formulary at HPPlans.com/Formulary.

For more information, call our Pharmacy Department at 215-991-4300 or our Provider Services Helpline at 1-888-991-9023 (Monday to Friday, 9 am to 4:30 pm).

November 26, 2025: DHS has released a Medical Assistance Bulletin outlining the Coverage Change and Prior Authorization of GLP-1 Receptor Agonists (Formerly Hypoglycemics, Incretin Mimetics/Enhancers and Obesity Treatment Agents) – Pharmacy Services.