Weight Management Resources
Overweight and obesity are common conditions in the United States. There are many factors that contribute to overweight and obesity, such as unhealthy eating behaviors, lack of sleep and physical activity, some medicines, high amounts of stress, as well as genetics and family history. Overweight and obesity are linked to many health problems, including heart disease, stroke, type 2 diabetes, and cancer. If you are diagnosed with overweight or obesity, talk with your healthcare provider and develop a treatment plan. We have put together the following resources in one easy to find location to help you manage your weight and lead a healthy lifestyle.
Announcement: At the March 9, 2026 State Employee Benefits Committee (SEBC) meeting, the Committee voted to increase the copay to $200 per 30-day supply for GLP-1 medications for weight management, such as Wegovy and Zepbound*, effective July 1, 2026 for non-Medicare prescription plan participants. This copay will be excluded from prescription out-of-pocket maximums.
* Zepbound is currently excluded from the State of Delaware’s formulary, however, coverage may be approved through the clinical exception process for eligible members. The $200 copay will apply to any current and future medications in this drug class.
Individuals with a diabetes diagnosis who are prescribed a GLP-1 medication in the diabetes class (such as Mounjaro, Ozempic or Trulicity) will continue to pay the $32 copay for a 30-day supply.
BENEFIT RESOURCES & INFORMATION
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 (877) 542-3862 or at the Aetna Member Website .
Please note: All bariatric surgeries are required to be completed under your Lantern benefit with a surgeon in the Lantern network. Bariatric surgery is not covered under your Aetna health plan and will not be eligible for a financial incentive.
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 (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 (844) 459-6452 or at the Highmark Delaware Member Website .
Please note: All bariatric surgeries are required to be completed under your Lantern benefit with a surgeon in the Lantern network. Bariatric surgery is not covered under your Highmark Delaware non-Medicare health plan and will not be eligible for a financial incentive.
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 ((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 coverage of weight loss medications comes 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 are required to work with both CVS Caremark and their medical providers to obtain coverage under the plan. Members can obtain the Coverage Review process online or contact CVS Caremark at (833) 458-0835. Weight loss medications available under the plan are determined by the CVS Caremark Formulary.
Additional Weight Management Resources are available through your Highmark Delaware or Aetna health care plan.