Frequently Asked Questions

Effective October 1, 2026, all GLP-1 inhibitor medications covered under the Alaska Electrical Health and Welfare Fund will require prior authorization through CVS Caremark.

This change applies to all GLP-1 inhibitors, including medications such as:

• Mounjaro
• Ozempic
• Wegovy

After reviewing utilization and costs, the Board of Trustees determined that the Plan’s current coverage approach was significantly broader than most plans because GLP-1 medications were covered without prior authorization.

The Trustees found that:

• Utilization of these medications has been very high
• Some utilization may not align with FDA guidelines
• Costs to the Fund exceeded $5 million in 2025

To help ensure appropriate use and manage Plan costs, the Trustees adopted a prior authorization requirement.

CVS Caremark will review information already available in its system, including:

• ICD diagnosis codes
• Prescription claims history

If CVS Caremark has enough information confirming a diagnosis of type 2 diabetes, prior authorization may not require additional action from you.

If additional confirmation is needed, CVS Caremark should send you and your prescribing physician a letter by October 1, 2026, requesting documentation confirming your diagnosis of type 2 diabetes.

Yes. Beginning October 1, 2026, all GLP-1 medications prescribed for weight loss will require prior authorization.

If you are currently prescribed GLP-1 medications, before October 1, 2026, CVS Caremark should contact both:

• You
• Your prescribing physician

The communication will explain the prior authorization process and any required documentation.

Typically, your prescribing physician submits the request on your behalf. However, you may wish to contact your physician to confirm that the request has been submitted.

CVS Caremark will follow FDA guidelines for GLP-1 medications used for weight loss. Generally, approval requires physician documentation showing:

• A BMI of 30 or greater, or
• A BMI of 27 or greater with qualifying comorbid conditions

Examples of qualifying comorbid conditions may include:

• Hypertension
• High cholesterol
• Diabetes

If you take a GLP-1 medication to maintain weight loss you may still qualify for approval if your physician can provide medical documentation showing that you meet CVS guidelines.

If you reach your BMI, you may still qualify if you meet CVS guidelines for maintenance.

Yes. You always have the right to appeal a medication denial.

No. The Trustees will not grant exceptions to CVS Caremark’s prior authorization requirements or approval criteria.

Yes. These medications remain broadly available through the marketplace.

No. If you purchase a GLP-1 medication without prior authorization:

• You will be responsible for the full cost
• Your expenses will not be reimbursed by the Plan
• Your payments will not count toward your deductible
• Your payments will not count toward your out-of-pocket maximums

CVS Caremark should send notices and instructions before October 1, 2026, to members who may be affected by the new prior authorization requirements.

If you have questions about the prior authorization process, required documentation, or to confirm approval contact CVS Caremark at (877) 478-1246. If you have questions about this new policy, plan eligibility or other health plan related information call the Admin Office at (907) 276-1246, option 3.