No, the West Virginia Public Employees Insurance Agency does not cover weight loss medication. PEIA ended its GLP-1 pilot program for obesity treatment in March 2024, and as of mid-2026 there is no replacement. The agency will still pay for GLP-1 drugs such as Ozempic when they are prescribed for Type 2 diabetes, and it offers two structured weight management programs and bariatric surgery coverage, but prescriptions written for weight loss alone are not a covered benefit.
Why PEIA Stopped Covering Weight Loss Drugs
From 2019 through early 2024, PEIA ran a pilot that provided GLP-1 medications like Wegovy and Zepbound to roughly 1,000 members through bariatric centers of excellence at WVU, Charleston Area Medical Center, and Cabell Huntington Hospital.1West Virginia Watch. West Virginia Lawmakers Hear Ideas for Stabilizing PEIA Participants lost an average of more than 14% of their body weight, with reported improvements in blood pressure, cholesterol, and A1c.2Capito.senate.gov. West Virginia Leaders Embrace Effects of Weight Loss Drugs While Also Considering Cost
The cost was the problem. Even after manufacturer rebates, the pilot ran about $1.3 million per month for those 1,000 members.3WV MetroNews. Concerned About Cost, PEIA Halted Pilot Program for Weight Loss Drugs PEIA officials estimated that opening coverage more broadly could cost between $130 million and $260 million a year net, with gross figures running higher. Senator Tom Takubo, who chairs the Joint Standing Committee on Insurance and PEIA, said the drug class had already cost the agency around $90 million and was “breaking the bank.”4West Virginia Public Broadcasting. State Employee Health Insurance Ends Pilot Program to Treat Obesity-Related Illness
PEIA paused the pilot on March 15, 2024, pointing to cost, drug supply shortages, side effects, and what it called inconclusive results. Members with active pre-authorizations kept their coverage through June 30, 2024, or the end of their authorization term, whichever came later.4West Virginia Public Broadcasting. State Employee Health Insurance Ends Pilot Program to Treat Obesity-Related Illness After that cutoff, participants had to pay out of pocket or stop the medication.
When PEIA Will Still Pay for a GLP-1
PEIA continues to cover GLP-1 medications for members who carry a Type 2 diabetes diagnosis. About 7,000 members use these drugs for diabetes management.3WV MetroNews. Concerned About Cost, PEIA Halted Pilot Program for Weight Loss Drugs In fiscal year 2024, GLP-1s accounted for $52.5 million of PEIA’s net pharmacy spending, roughly 20% of its total drug bill.1West Virginia Watch. West Virginia Lawmakers Hear Ideas for Stabilizing PEIA
PEIA Director Brian Cunningham put the position bluntly at a November 2024 legislative hearing: “we simply can’t afford to provide GLP-1s for weight management that are not rebated.”1West Virginia Watch. West Virginia Lawmakers Hear Ideas for Stabilizing PEIA A prescription from your doctor with a weight-loss indication, or a diagnosis of obesity without diabetes, will not be reimbursed.
To check whether a specific medication is on the plan, PEIA members can search the five-tier value formulary, effective May 2026, through the agency’s prescription benefits page. Pharmacy benefits are managed through Express Scripts.5PEIA. Prescription Benefits
What PEIA Covers Instead
Members looking for help with weight loss have three covered paths that do not involve drug therapy.
Face-to-Face Weight Management Program
This is a 24-month, in-person program run through approved West Virginia facilities. Participants work with registered dietitians, exercise physiologists, and personal trainers through baseline assessments, 10 facility visits per month, monthly follow-ups, personal training, and food journaling. To qualify, members must be at least 18 and have a BMI of 25 or higher, or meet specific waist circumference thresholds. The cost is a $30 monthly copay with no deductible or coinsurance.6PEIA. Weight Management Program It is a once-in-a-lifetime benefit, with a maximum of two enrollment attempts separated by a one-year waiting period.7PEIA. Weight Management Program FAQs
Wondr Health
Formerly called Naturally Slim, Wondr is a digital program offered at no cost to PEIA policyholders and their adult dependents. The curriculum centers on mindful eating rather than calorie counting, with ten weekly lessons followed by reinforcement and maintenance content. Enrollment opens in windows during the plan year. Starting in July 2024, members who had previously completed the program became eligible to enroll a second time.8PEIA. Wondr
Bariatric Surgery
PEIA covers bariatric surgery with prior authorization. According to a 2017 policy document, approval required completion of the PEIA Weight Management Program or an alternative program with documented 10% weight loss over 12 months, with a $500 copay and 20% coinsurance. That same policy stated that members who used weight loss drugs to achieve their qualifying weight loss were not eligible for surgery coverage.9GW STOP. State Employee Obesity Coverage – West Virginia If you have already had bariatric surgery, you may apply for the Face-to-Face Weight Management Program only after 10 years have passed since the procedure.7PEIA. Weight Management Program FAQs
Could Weight Loss Drug Coverage Come Back?
Lawmakers have filed several bills to force PEIA or insurers to cover GLP-1s for weight loss, and none have passed.
- House Bill 4979, introduced during the 2024 regular session by Delegate Kayla Young, would have mandated insurance coverage for GLP-1 medications. It stalled in the House Committee on Banking and Insurance.4West Virginia Public Broadcasting. State Employee Health Insurance Ends Pilot Program to Treat Obesity-Related Illness
- House Bill 116, introduced by Delegate John Williams during the 2024 special session, would have required PEIA to reimburse for physician-prescribed GLP-1 agonists for weight loss starting July 1, 2024. It died in the House Finance Committee.10BillTrack50. HB116
- House Bill 5153, introduced by Delegate Young on February 3, 2026, would coordinate obesity prevention and treatment programs. Its fiscal note estimated that requiring PEIA to cover GLP-1s for obesity would cost about $13.5 million per month, or $162 million a year, based on a 41.4% obesity rate, 30% utilization, and a net cost of $499 per prescription. As of mid-2026, the bill is still pending in the House Health and Human Resources Committee.11WV Legislature. Fiscal Note for HB515312Fast Democracy. HB 5153
Senator Takubo has said legislators are working “creatively behind the scenes” with drug manufacturers to find a financially workable path back to coverage, and that any future program would require clear “parameters around qualifying criteria.”4West Virginia Public Broadcasting. State Employee Health Insurance Ends Pilot Program to Treat Obesity-Related Illness For now, members who want a GLP-1 for weight loss without a diabetes diagnosis will need to pay out of pocket or ask their prescriber about manufacturer assistance programs.