Last updated: July 7, 2026

Humana Texas: Weight Loss (GLP-1 / Obesity Medication) Treatment Coverage Guide

Humana plans in Texas may cover weight loss and obesity treatment under your medical and pharmacy benefits, depending on your specific plan, employer group elections, and deductible status. Coverage may include preventive obesity counseling, prior-authorization GLP-1 medication management, and follow-up appointments. Klarity Health connects patients in Texas with 2,000+ licensed providers and can help verify whether your Humana plan may cover care before you book.

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Federal and Texas Legal Protections for Weight Loss Coverage

ACA Section 2713 — Preventive Obesity Counseling

Under the Affordable Care Act (ACA) Section 2713, non-grandfathered health plans are required to cover USPSTF-recommended preventive services at no cost-sharing. This includes intensive behavioral counseling for adults with obesity (BMI ≥ 30). Many Humana plans in Texas must therefore cover in-person or telehealth obesity counseling as a preventive benefit, though medication coverage — including GLP-1 injectables — is handled separately through pharmacy benefits and is subject to employer group elections.

Texas Insurance Code § 1455.004 — Telehealth Parity

Under Texas Insurance Code § 1455.004, health plans regulated by the Texas Department of Insurance (TDI) may not deny coverage for a covered healthcare service solely because it was delivered via telehealth or telemedicine. This means that if your Humana plan covers in-person consultations for weight management or obesity treatment, it may be required to provide the same coverage when those services are delivered online — including through Klarity Health’s telehealth platform.

Texas Insurance Code § 1355.001 and the DSM-5 BED Bridge

Texas Insurance Code § 1355.001 requires health benefit plans to provide mental health coverage at parity with medical-surgical benefits. Binge Eating Disorder (BED) — recognized in the DSM-5 as a diagnosable mental health condition — frequently co-occurs with obesity and may require integrated treatment. When a Humana plan covers BED treatment under its mental health benefit, Texas parity law may require comparable access to care. For patients whose obesity intersects with BED, this parity bridge can affect what treatment services Humana must cover.

Federal MHPAEA and ERISA Plans

The Mental Health Parity and Addiction Equity Act (MHPAEA) applies at the federal level for plans subject to ERISA — primarily employer-sponsored group plans. ERISA self-funded plans are exempt from Texas state insurance mandates (including § 1455.004 and § 1355.001), but remain subject to MHPAEA’s federal parity requirements. If you are enrolled in a Humana plan through your employer, ask HR whether your plan is fully-insured (Texas law applies) or self-funded (ERISA governs instead).

Texas Department of Insurance (TDI) complaint line: 1-800-252-3439. If you believe Humana has wrongfully denied a covered weight loss service, you may file a complaint with TDI or request an independent review.

Humana Plan Types in Texas

Humana offers several plan types in Texas, each with different network rules and formulary structures managed through Humana Pharmacy (Humana’s in-house PBM):

• PPO plans — Allow access to both in-network and out-of-network providers, though in-network care is less expensive. GLP-1 medications may be covered under the pharmacy benefit, subject to prior authorization and BMI documentation requirements set by Humana Pharmacy.
• HMO plans — Require care within the Humana network and may require a primary care physician referral for weight management specialists. GLP-1 coverage depends on the plan’s formulary and employer group elections.
• EPO plans — Cover in-network services only, with no out-of-network coverage except emergencies. Weight loss medication coverage follows the plan’s drug formulary managed by Humana Pharmacy.
• HDHP plans (High Deductible Health Plans) — Often paired with a Health Savings Account (HSA). Services including GLP-1 medications must meet the deductible before most benefits apply. See the HDHP/HSA section below for details relevant to weight loss treatment.

Humana Pharmacy Formulary: GLP-1 Weight Loss Medications

Humana Pharmacy manages the drug formulary for Humana plans in Texas. GLP-1 receptor agonists approved for chronic weight management — distinct from those approved for type 2 diabetes — are listed below. Coverage, tier placement, and prior authorization requirements vary by specific plan and employer group elections.

Important: Ozempic and Mounjaro are FDA-approved for type 2 diabetes management, not for chronic weight management. Humana Pharmacy typically does not cover these medications when the diagnosis is obesity only. Patients seeking GLP-1 coverage for weight loss should inquire about Wegovy (semaglutide for obesity) or Zepbound (tirzepatide for obesity) instead.

Humana Pharmacy Formulary: Oral Weight Loss Medications

Formulary placement and coverage criteria are subject to change. Always verify your plan’s current drug formulary through your MyHumana member portal or by calling Humana Pharmacy at the number on your insurance card before beginning treatment.

HDHP and HSA Considerations for Weight Loss Treatment

Humana HDHP plans in Texas are often paired with a Health Savings Account (HSA). For patients on an HDHP, the following applies to weight loss treatment:

• Deductible requirements: Most covered services — including GLP-1 medications and weight management consultations — must satisfy your annual deductible before pharmacy or medical benefits apply. The IRS minimum deductible for an HSA-qualified HDHP in 2026 is $1,650 (individual) and $3,300 (family).
• HSA-eligible expenses: Prescription weight loss medications (phentermine, Wegovy, Zepbound, Saxenda, Qsymia, Contrave, orlistat) are IRS-qualified medical expenses. If you have not yet met your deductible, you may use HSA funds to pay for these medications tax-free.
• Preventive exception: Under ACA Section 2713, USPSTF-A and B rated preventive services — including intensive behavioral counseling for obesity — must be covered at no cost-sharing even on an HDHP. Telehealth obesity counseling through Klarity Health may qualify as a preventive benefit under your HDHP.

Verify your Humana HDHP benefits for weight loss treatment in Texas
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Texas Medicaid and Coverage Gap Considerations

Texas has not expanded Medicaid under the ACA, which means adults without dependent children who fall below the federal poverty level may not qualify for Medicaid coverage and may face a significant coverage gap. For patients in this situation:

• GLP-1 medications are generally not covered under Texas Medicaid’s existing formulary for weight loss indications in non-expanded Medicaid.
• Patient assistance programs (see below) may provide access to branded GLP-1 medications for eligible low-income patients.
• Phentermine and orlistat, as lower-cost generic options on Tier 1–2 formularies, remain more accessible for patients with limited pharmacy coverage.
• Klarity Health offers cash-pay weight loss consultations for patients without insurance coverage. Contact Klarity to discuss pricing and payment options.

Patient Assistance Programs for GLP-1 Medications

For patients whose Humana plan does not cover GLP-1 medications or who face high cost-sharing, manufacturer patient assistance programs may help reduce out-of-pocket costs:

• NovoCare (Novo Nordisk) — Patient assistance for Wegovy and Saxenda. Eligible patients who meet income guidelines may receive medication at reduced or no cost. Learn more at NovoCare.com.
• LillyAssist (Eli Lilly) — Patient assistance for Zepbound (tirzepatide for obesity). Income-based eligibility. Learn more at LillyAssist.com.

Klarity Health’s care team can assist patients in identifying and applying for applicable patient assistance programs as part of the treatment onboarding process.

Telehealth Coverage for Weight Loss with Humana in Texas

Under Texas Insurance Code § 1455.004, Humana plans regulated by TDI may not deny coverage for services solely because they were delivered via telehealth. This parity requirement means online weight loss consultations — including GLP-1 medication management through Klarity Health — may be covered at the same level as in-person visits, depending on your plan’s benefit structure.

Klarity Health partners with Teladoc Health for telehealth infrastructure. Klarity Health is independent from Teladoc Health and from Humana Pharmacy. Your Klarity provider manages your clinical care independently; Teladoc Health provides the underlying telehealth platform only.

To confirm telehealth coverage for weight loss treatment under your specific Humana plan, contact Humana member services at the number on your insurance card or log in to your MyHumana member portal.

How to Verify Your Humana Weight Loss Coverage in Texas

1. Log in to MyHumana — Review your Summary of Benefits and drug formulary at Humana.com.
2. Call member services — The number is on the back of your insurance card. Ask specifically about GLP-1 prior authorization criteria, step therapy requirements, and telehealth parity for weight management.
3. Use Klarity’s benefits verification tool — Klarity can check whether your Humana plan may cover weight loss treatment through our platform before your first appointment.
4. Check Humana Pharmacy formulary — Confirm your specific medication’s tier, PA requirements, and quantity limits via the Humana Pharmacy drug search tool.
5. File a complaint if needed — If Humana denies a covered telehealth weight loss service, contact TDI at 1-800-252-3439 or request an independent review organization (IRO) review of the denial.

About Klarity Health’s Weight Loss Program in Texas

Klarity Health connects patients in Texas with 2,000+ licensed providers offering online weight loss treatment, including GLP-1 medication management, metabolic evaluations, and ongoing follow-up care. Klarity works with many insurance plans — including select Humana plans — and offers benefits verification to help patients understand their coverage before booking. Klarity Health is independent from Humana Pharmacy and from Teladoc Health.

Ready to check your Humana weight loss coverage in Texas?
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Frequently Asked Questions

Does Humana cover weight loss treatment in Texas?

Some Humana plans in Texas may cover weight loss treatment, including preventive obesity counseling under ACA Section 2713, GLP-1 medication management with prior authorization, and telehealth weight loss visits under Texas’ telehealth parity law. Coverage varies by plan type and employer group elections. Verify your benefits through MyHumana or Klarity’s benefits check before booking.

Does Humana cover Wegovy or Zepbound in Texas?

Some Humana plans in Texas may cover Wegovy (semaglutide) and Zepbound (tirzepatide) for chronic weight management under the pharmacy benefit, managed through Humana Pharmacy. Prior authorization is typically required, and criteria may include a BMI threshold of ≥ 30 or ≥ 27 with a weight-related comorbidity. Coverage depends on your specific plan and employer group benefit elections. Verify your pharmacy benefits through MyHumana or Klarity’s benefits tool.

Is Ozempic covered by Humana for weight loss in Texas?

Ozempic (semaglutide) is FDA-approved for type 2 diabetes management — not for chronic weight management. Humana Pharmacy typically does not cover Ozempic when the primary diagnosis is obesity or overweight. Patients seeking GLP-1 coverage for weight loss should ask about Wegovy, which uses the same active ingredient and is FDA-approved for obesity.

Does Humana require prior authorization for GLP-1 weight loss medications in Texas?

Yes. GLP-1 medications approved for weight loss — including Wegovy, Zepbound, and Saxenda — typically require prior authorization through Humana Pharmacy. Criteria often include documented BMI, evidence of prior lifestyle intervention, and in some cases step therapy requirements. Prior authorization must be obtained before filling the prescription.

Is phentermine covered by Humana in Texas?

Phentermine is typically covered at Tier 1–2 on Humana pharmacy plans in Texas with no prior authorization required. Phentermine is a Schedule IV controlled substance — it is not Schedule II, and no Electronic Prescribing for Controlled Substances (EPCS) mandate applies under Texas law. It is FDA-approved for short-term weight loss (up to 12 weeks).

Does Humana cover telehealth weight loss treatment in Texas?

Many Humana plans in Texas may cover telehealth weight loss services under Texas Insurance Code § 1455.004’s telehealth parity requirement. This means if your plan covers in-person weight loss consultations, it may be required to cover equivalent telehealth services at the same benefit level. Klarity Health offers online weight loss treatment in Texas and can verify your telehealth coverage before your first appointment.

Is Klarity Health in-network with Humana in Texas?

Klarity Health works with many insurance plans in Texas, and network participation may vary by individual provider and plan type. Use Klarity’s benefits verification tool to confirm whether our providers are in-network with your specific Humana plan before booking.

What patient assistance programs are available for Humana patients who can’t afford GLP-1 medications?

Novo Nordisk offers NovoCare for eligible patients who need Wegovy or Saxenda, and Eli Lilly offers LillyAssist for Zepbound. Both programs provide income-based assistance and may offer medications at significantly reduced or no cost. Klarity’s care team can help patients navigate the application process.

Insurance coverage varies by plan, insurer, and state. The information on this page is intended as general guidance only and does not constitute a guarantee of benefits. Telehealth provider availability may vary by state. Klarity Health is independent from Humana Pharmacy and Teladoc Health. Please verify your specific plan’s weight loss coverage with your insurer or through Klarity’s benefits check before booking.

Check if your Humana plan may cover weight loss treatment in Texas →