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Department of Human Resource Management
Office of State Health Benefits
August 12, 2026
Updated Weight Loss Glp‑1 Prior Authorization Criteria
(This update replaces the GLP‑1 information originally published in Spotlight on Your Benefits – Spring 2026)
The prior authorization (PA) criteria for GLP‑1 medications used for weight loss has been updated. The 2026 Spotlight publication stated that current users would be required to meet the new BMI requirement of 35 or higher once their existing prior authorization (PA) expired. This guidance has been revised.
Existing Users – Revised Guidance
Members who are currently using GLP 1 weight loss medications under an active PA, and remain continuously compliant, will not be required to meet the new BMI ≥ 35 criteria when their PA renews. Instead, existing users will continue to be evaluated under the previous criteria, which require an initial BMI of either:
- BMI of 30 or greater, OR
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BMI of 27 or greater with at least one qualifying comorbidity, including:
- Hypertension
- Diabetes
- Dyslipidemia
- Obstructive sleep apnea
- Cardiovascular disease
All other applicable prior authorization requirements remain in effect.
New Users – Effective July 1, 2026
Any initial authorization request for GLP 1 therapy for weight loss submitted on or after July 1, 2026 must meet the new PA criteria, including:
- Body Mass Index (BMI) of 35 or higher, and
- All other applicable prior authorization requirements
Premium Rewards Requirements Document Updated
The Premium Rewards Requirements document has been updated to reflect two key changes: a revised lookback period for Premium Rewards effective after Open Enrollment, and a faster processing timeline for Premium Rewards within Cardinal.
The updated document is now available on the DHRM website.
Sentara Health Provider Network to leave the Anthem Network
Sentara’s provider contracts with Anthem are scheduled to expire on December 31, 2026, unless a new agreement is reached. At this time, members should not experience any disruption in access to Sentara providers or services.
Negotiations between Anthem and Sentara are ongoing. Members seeking the most current information can visit Anthem’s dedicated page, Anthem Negotiations with Sentara Health or contact Anthem directly with questions.
OHB is closely monitoring the situation and remains optimistic that both Anthem and Sentara will reach a mutually agreeable resolution.
Please do not reply to this e-mail. You may send inquiries to the Office of Health Benefits mailbox at ohb@dhrm.virginia.gov.
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