Beginning with the upcoming plan year (July 1, 2026 – June 30, 2027), the University of New Mexico (UNM) Prescription Drug Plan does not cover GLP-1 medications when they are prescribed solely for weight management. GLP-1 medications that are prescribed for other medical conditions may still be eligible for coverage. This change was made to ensure long-term financial sustainability of the UNM health plan while continuing to support employee health and wellbeing. Click here for more information on GLP-1 medications for weight management.
UNM recognizes the impact this change may have on employees using GLP-1 medications for weight management. To support affected employees, UNM will be offering short-term financial support and transition assistance through a Health Reimbursement Arrangement (HRA), administered by WEX Health Inc.
An employer-sponsored Health Reimbursement Arrangement (HRA) is a UNM-funded benefit that helps eligible employees pay for qualified medical expenses by reimbursing them for costs incurred. HRAs are owned and funded entirely by the employer, are not taxable income to employees, and provide flexibility to help offset out-of-pocket healthcare expenses in coordination with an employee's medical plan.
Benefits eligible employees hired before July 1, 2026, who remain actively enrolled in either the UNM LoboHealth or Presbyterian health plans will be automatically enrolled and eligible to submit claims. The HRA will reimburse up to $150 per month (for a 30-day supply)for expenses incurred for medically necessary GLP-1 medications (Zepbound and Wegovy) prescribed for weight management. Unused amounts will be forfeited and may not rollover.
Under IRS regulations, if a dependent's expenses are reimbursed from the participant's HRA, the dependent must be enrolled as an eligible dependent in the health plan and listed as the recipient or patient on submitted documentation. For more information about eligible dependents, visit the Eligibility webpage.
Claims for reimbursement must be submitted to WEX Health Inc. for review, substantiation, and processing. The IRS requires you to provide documentation to make sure expenses are eligible for reimbursement from your Health Reimbursement Arrangement (HRA). If you provide documentation but it's not sufficient to substantiate the claim, you'll receive a request for more information.
You are required to substantiate:
The GLP-1 HRA is designed to allow you access to employer contributions to pay for eligible GLP-1 medications and offset your out-of-pocket costs. The HRA will reimburse up to $150 per month (for a 30-day supply) for expenses incurred for medically necessary GLP-1 medications prescribed for weight management
You must be hired prior to 7/1/2026 and have maintained active UNM health insurance coverage from the FY26 Plan Year (July 1, 2025 - June 30, 2026) into the FY27 Plan Year (July 1, 2026 - June 30, 2027) with no gap in coverage.
Yes, as long as your spouse/dependent meets the eligibility requirements any eligible GLP-1 expenses can be reimbursed under the HRA.
Zepbound and Wegovy
Yes, Express Scripts offers a program that allows you to purchase certain weight-loss GLP-1 medications at a discounted price, even if they are not covered under the UNM prescription plan. You can log in to the Express Scripts website to check your coverage and view estimated costs.
Your prescription will still undergo important safety reviews for drug interactions and other clinical concerns. The discounted cash price you pay will not count toward your deductible or out-of-pocket maximum. Participation in this program does not change your plan’s coverage rules or approval requirements.
To take advantage of the discounted cash price, you must have a valid prescription and present your Express Scripts prescription card, just as you would for prescriptions covered by the plan. The pharmacy will process the prescription through its system and advise you of the amount owed.
A claim may be submitted to WEX for eligible GLP-1 out-of-pocket expenses through your online WEX Account or WEX mobile app. You will need to provide a valid prescription from your physician for the GLP-1 medication, along with an itemized receipt from your pharmacy.
For a 90-day supply, a monthly claim will need to be submitted along with a valid prescription to be reimbursed up to the $150 monthly maximum.
If you are submitting a completed claim form via fax or email to WEX, please ensure you enter “HRA” under the *Plan Type of the “Claim Reimbursement Information” section.
Reimbursements can be made either via check or direct deposit when filing a claim with WEX. To request a direct deposit reimbursement, complete the steps to set up direct deposit within your online WEX account.
No, funds will not roll over month-to-month or between plan years. Claims may be submitted for a previous month’s prescription if you were eligible and purchased the GLP-1 within that month.
Be prepared to provide the last four digits of your UNM ID (in lieu of SSN) so WEX can access your FSA account details.
