GLP-1 medications prescribed for obesity and related conditions are subject to 50% coinsurance.  

This requirement follows a directive from the Office of Personnel Management (OPM). The directive was communicated to health plans by email rather than through the public carrier letter process.

Your cost will vary depending on the pharmacy you use and the price of the medication. Under FSBP, you are responsible for 50% of the cost of the drug.

Based on pricing available in late October 2026, members can expect to pay more than $500 per month or approximately $1,500 for a 90-day supply.

Yes. The amount you pay for covered GLP-1 medications, along with other covered medical services and prescription drugs, counts toward your annual out-of-pocket (OOP) maximum.

Your out-of-pocket maximum is the most you will pay for covered services during a calendar year, subject to Plan rules.

For 2027, the in-network out-of-pocket maximums are:

• Self Only: $6,000 (no change)

• Self Plus One and Self & Family: $12,000

For members with Self Plus One or Self & Family coverage, once one covered family member reaches the individual out-of-pocket maximum of $6,000, FSBP will begin paying 100% of that individual’s covered costs for the remainder of the calendar year.

Possibly. Some drug manufacturers offer coupons that may help reduce your out-of-pocket costs.

However, eligibility is determined by the manufacturer, and approval may not be confirmed until your prescription is filled.

FSBP, Express Scripts, and their affiliated organizations cannot guarantee that a member will qualify for or be able to use a manufacturer coupon.

If you are considering using a coupon, we encourage you to carefully review the manufacturer’s terms, conditions, and eligibility requirements.

If you qualify for a coupon, you may use it to help pay your portion of the coinsurance.

FSBP has partnered with Express Scripts and Teladoc Health to offer the EncircleRx program, which launched in 2026. Members prescribed GLP-1 medications for weight management and other eligible conditions must participate in this program to receive and maintain coverage.

Note: The Teladoc Health programs are not available everywhere in the world. Members filling their prescriptions overseas are not required to participate in this program. However, members living overseas and filling their prescriptions from U.S. pharmacies and living in areas where Teladoc Health is not available should contact FSBP for guidance.

Here’s how the EncircleRx program works:

Step 1: Enroll in a Teladoc Health Program

Before filling your first prescription under FSBP, you must enroll in one of the following Teladoc Health programs:

• Advanced Weight Management

• Advanced Diabetes Prevention Program

There is no additional cost to participate in either program.

You can enroll at https://www.teladochealth.com/expert-care/condition-management

Step 2: Obtain Prior Authorization

Once enrolled, ask your healthcare provider to submit a prior authorization request to Express Scripts to confirm that you meet the eligibility requirements for the medication.

Prior authorization means your provider must submit information to the Plan for review and approval before your medication can be covered. This typically involves completing a questionnaire and providing supporting medical documentation.

Step 3: Fill Your Prescription

Once you are enrolled in the Teladoc Health program and your prior authorization is approved, you can fill your first prescription.

Step 4: Stay Engaged to Maintain Coverage

To continue receiving coverage for future refills, you must actively participate in your Teladoc Health program throughout the year.

Each month, you must complete two requirements:

1. Weigh in at least four times per month: Use your Teladoc-provided scale to record your weight on four separate days each month.

2. Engage with the Teladoc app at least four times per month: You can choose from several activities, including tracking physical activity, logging meals, reading educational articles, or speaking with a health coach.

Important: If you do not meet both monthly requirements, your coverage for future refills will not continue. Ongoing participation is necessary to maintain coverage throughout the year.

The Office of Personnel Management (OPM) requires members using GLP-1 medications for weight management to participate in an intensive behavioral therapy (IBT) program.

This type of program focuses on helping individuals develop and maintain healthy habits through education, coaching, and ongoing support.

FSBP meets this requirement through the EncircleRx program, which includes ongoing support from Teladoc Health.

Please refer to the previous question for details about enrollment and participation requirements.

You may purchase your GLP-1 medications through TrumpRx or other third-party programs. However, FSBP will only cover these medications when they are purchased through a network pharmacy and you meet the Plan’s prior authorization and program participation requirements.

If you purchase your medications outside the Plan’s pharmacy network, those expenses will not count toward your annual out-of-pocket maximum.

Under the FSBP-Express Scripts Medicare Prescription Drug Plan (PDP), GLP-1 medications for weight loss are classified as Tier II drugs.

Members enrolled in the PDP pay a $60 copayment for a 90-day supply.

Unlike members receiving prescription drug coverage through FSBP High Option, members enrolled in the FSBP-Express Scritps Medicare PDP are not required to participate in EncircleRx or engage with Teladoc Health to maintain coverage.

However, some Teladoc Health support services are available to PDP members who choose to participate.

Members eligible for the PDP may save money on these medications by enrolling in the PDP.

GLP-1 medications may be approved for different uses depending on the country where they are prescribed or purchased.

For example, in some countries, Mounjaro may be approved to treat both diabetes and weight management.

• If your GLP-1 medication is prescribed for diabetes: When you fill your prescription at a retail pharmacy outside the United States, you are responsible for the standard 10% coinsurance for prescription drugs purchased overseas. However, FSBP may request medical documentation to confirm your diabetes diagnosis.
• If your GLP-1 medication is prescribed for weight management or another condition: When you fill your prescription at a retail pharmacy outside the United States, you are responsible for 50% coinsurance.

Note: Members filling their prescriptions overseas are not required to participate in the EncircleRx Program, as Teladoc Health programs are not available everywhere in the world. However, members who live overseas, fill their prescriptions from U.S. pharmacies, and reside in areas where Teladoc Health is not available should contact FSBP for guidance.

GLP-1 medications may also be prescribed to treat other medical conditions, including:

• Metabolic Dysfunction-Associated Steatohepatitis (MASH): A liver condition associated with fat buildup and inflammation.

• Obstructive Sleep Apnea (OSA): A condition in which breathing repeatedly stops and starts during sleep.

If you are prescribed Wegovy or Zepbound for these or other non-diabetes conditions, the same coverage requirements apply.

You will be responsible for 50% coinsurance and must participate in the EncircleRx program to maintain coverage.