Express Scripts Announces Changes for Participants Prescribed GLP-1s for Weight Loss: Effective January 1, 2026

December 18, 2025

Attention NYCDCC Welfare Fund Participants currently prescribed GLP-1s for weight loss: Effective January 1^st, 2026, there will be new requirements that must be met in order to continue having your prescription covered under the Plan. These requirements, which are also detailed in a recent letter sent to you by Express Scripts, are as follows:  

• Participants MUST enroll with Omada, a virtual health program. The purpose of this program is to help members create healthier habits to achieve long lasting results.
  • Once enrolled with Omada, participants must meet the following requirements each month:
    • Use the Omada app four times, by completing lessons or engaging with a health coach, peer group, or online community, and
    • Weigh in four times using the smart scale provided by Omada.

To enroll in Omada, sign up at omadahealth.com/esi or download the Omada mobile app.

• Once the participant has enrolled with Omada, your provider must submit a NEW Prior Authorization to Express Scripts. Even if there was an existing Prior Authorization on file, the existing Prior Authorization will be terminated as of January 1, 2026. Providers can visit EviCore (evicore.com) or call Express Scripts at (800) 417-1764 to submit a new Prior Authorization.

Kindly note, there will be a 24-hour waiting period before the Omada Enrollment will be available to ESI. Providers can submit a new Prior Authorization 24 hours after the Omada enrollment is completed.

If you have further questions regarding these changes, please contact Express Scripts directly at (800) 939-2091.