The following Aetna programs and services are available to currently enrolled Aetna State of Delaware non-Medicare health plan members. Members are also encouraged to contact Aetna at 1-877-542-3862 or at the Aetna Member Website.

Available at No Cost to Members

Aetna Member Website: The Aetna Member Website includes an extensive library of articles, recipes, and videos that support members on various health topics, including weight loss.

Aetna One Advisor: Get telephonic and digital support on managing your health, coordinating your care, and meeting your weight management goals. Call 1-877-542-3862 to get started!

Diabetes Prevention Program: Helps members eat healthier, increase physical activity, and lose weight. Learn more.

Discounts: Save on gym memberships, weight loss programs, meal plans, and more with the discount programs and services from Aetna. Visit the Aetna Member Website for details on how to get started.

Available with Associated Costs to Members

View your Plan Booklet (HMO Plan or CDH Gold Plan) for more information including costs, or contact Aetna.

Nutritional Counseling: Services are provided for the assessment and guidance of members at nutritional risk due to nutritional history, current dietary intake, medication use, or chronic illness. Nutritional counselling is covered for certain diagnoses, including diabetes and cardiovascular disease. Nutritional counseling benefits are not provided for weight loss in the absence of co-morbid conditions.

Obesity Screening and Counseling: Coverage includes preventive counseling visits and/or risk factor reduction intervention, medical nutrition therapy, nutrition counseling, and healthy diet counseling visits provided in connection with high cholesterol and other known risk factors for cardiovascular and diet-related chronic disease.

The following Highmark Delaware programs and services are available to currently enrolled Highmark Delaware State of Delaware non-Medicare health plan members. Members are also encouraged to contact Highmark Delaware at 1-844-459-6452 or at the Highmark Delaware Member Website.

Available at No Cost to Members

Highmark Wellness Coaching (Custom Care Management Unit - CCMU): Get personalized coaching from your own Highmark Wellness Coach. Call the phone number on the back of your Highmark ID card to get connected (1-844-459-6452). Your wellness coach can support you with a variety of wellness goals:

• Losing weight or weight management
• Sleeping better
• Reducing stress
• Choosing healthy foods and beverages as well as healthy portion sizes and snacks
• Increasing physical activity
• And more!

Diabetes Prevention Program: Helps members eat healthier, increase physical activity, and lose weight. Learn more.

Blue 365 Discount Program: Whether you are looking for discounted gym memberships, weight loss programs, or meal plans, it can all be found on the Blue 365 Website.

Available with Associated Costs to Members

View your Plan Booklet (First State Basic Plan or Comprehensive PPO Plan) for more information including costs, or contact Highmark Delaware.

Nutritional Counseling: Services are provided for the assessment and guidance of members at nutritional risk due to nutritional history, current dietary intake, medication use, or chronic illness. Nutritional counselling is covered for certain diagnoses, including diabetes and cardiovascular disease. Nutritional counseling benefits are not provided for weight loss in the absence of co-morbid conditions.

Obesity Screening and Counseling: Coverage includes annual preventive office visits for obesity and blood pressure measurement, additional nutritional counseling for obesity, and recommended lab tests in connection with high cholesterol and other known risk factors for cardiovascular and diet-related chronic disease.

The State Employee Benefits Committee (SEBC) voted to provide coverage for weight loss medications under the State’s pharmacy benefits through CVS Caremark for non-Medicare prescription plan participants effective July 1, 2023. This decision was made to support State of Delaware health plan members in their weight management efforts.

The coverage of these medications will come with Utilization Management. Utilization Management (UM) programs review prescription drugs for medical necessity, appropriate use and safety, and include prior authorization, quantity limits and/or required use of lower-cost options before coverage of certain drugs.

Prior authorization requirements align with the FDA label for each medication and current clinical guidelines. These include, but are not necessarily limited to:

• Diagnosis of obesity or overweight with at least one weight related comorbid condition,
• Previous participation in a comprehensive weight management program,
• Continued use with a reduced calorie diet and exercise, and
• Achieving or maintaining a positive clinical response.

Members will be required to work with both CVS Caremark and their medical providers to obtain coverage under the plan beginning July 1, 2023. Members can obtain the Coverage Review process online or contact CVS Caremark at 1-833-458-0835. Weight loss medications available under the plan will be determined by the CVS Caremark Formulary.

Additional Weight Management Resources are available through your Highmark Delaware or Aetna health care plan.