Kansas state employee health plan raises GLP-1 BMI cutoff to 35 for weight management

Starting January 1, 2026, the Kansas State Employee Health Plan will cover GLP-1 medications for weight management only for members with a body mass index (BMI) of 35 or higher. The requirement applies to all GLP-1 prescriptions for weight management that are issued or renewed after that date ^[1].

The change also sets a preferred-drug order. Wegovy is the plan's preferred GLP-1 for weight management. Zepbound is non-preferred unless the member has previously tried and failed a preferred product, or is unable to use one for medical reasons. In that situation, the member's provider can submit medical documentation to Caremark, the plan's pharmacy benefit manager, to request an exception ^[1].

All anti-obesity medications under the plan require prior authorization through Caremark, which sets prior authorization criteria for each medical condition it approves for treatment ^[1]. Prior authorization is required for new users, and the plan says coverage will need to be re-approved periodically with documentation supporting continued use and effectiveness at reducing weight ^[1].

The plan describes the new requirements as a way to "help keep health care affordable and sustainable" ^[1]. It says its cost to provide this coverage "has increased significantly in the last year," affecting both the plan and member costs, and that because the drugs are an ongoing expense, the financial impact is long term ^[1]. The plan also notes that many employer health plans across the country are struggling to keep covering these drugs, that some state employee health plans have eliminated coverage entirely, and that others — the group it places itself in — have added new guidelines instead ^[1].

The plan's page does not say what BMI cutoff was in place before January 1, 2026, how many members will be affected, or what the change is expected to save. Those figures have not been disclosed ^[1].

Why it matters for patients

For Kansas state employees and covered family members, the practical effect depends on BMI and on which drug is prescribed. Under the criteria as described, coverage of a GLP-1 for weight management requires a BMI of 35 or higher, so a member below that threshold would not meet the plan's stated requirement for weight-management coverage ^[1].

Members at or above 35 are not automatically cleared: prior authorization is still required, and continued coverage depends on periodic re-approval with documentation of ongoing use and weight reduction ^[1].

Zepbound users who have not first tried and failed a preferred product face an added step. Their provider must submit medical documentation and Caremark must review and approve an exception before the drug is covered ^[1]. The plan's page frames the BMI and preferred-drug rules as requirements for weight-management prescriptions. It states that prior authorization criteria are established for each medical condition approved for treatment, but it does not spell out how the BMI threshold applies to GLP-1 prescriptions written for other approved conditions; that has not been explained ^[1].

The plan continues to offer non-drug weight management options, including an 8-week HealthQuest course through Marathon Health and individual health coaching sessions ^[1].

What happens next

The new criteria take effect January 1, 2026, and apply to weight-management GLP-1 prescriptions issued or renewed on or after that date ^[1]. The plan directs members with questions to their HR representative, to Caremark for plan details, or to the HealthQuest health and wellness program, which includes weight-loss health coaching ^[1]. No further changes after that date have been reported ^[1].