Humana West Virginia Weight Loss Treatment Coverage | Klarity Health

Humana West Virginia: Weight Loss Treatment Coverage Guide

Humana plans in West Virginia may cover weight loss treatment under your health benefits, depending on your specific plan, deductible status, and medical necessity criteria. Coverage may include provider consultations, medication management, and follow-up appointments. Klarity Health offers online weight loss treatment and works with many insurance plans. You can check whether your Humana plan may cover care at Klarity before booking.

Medicare GLP-1 Bridge: $50/Month for Eligible Humana Medicare Advantage Members

Effective July 1, 2026, eligible Humana Medicare Advantage (MAPD) members may access Wegovy (semaglutide), Zepbound (tirzepatide), and Foundayo (semaglutide) at $50 per month through the CMS Medicare GLP-1 Bridge program. This benefit is provided via CMS — it is separate from and in addition to Humana Pharmacy Solutions (HPS) Part D formulary coverage. Eligible members should contact Humana member services at 1-800-448-6262 or 1-800-633-4227 (CMS) to learn more about accessing this benefit.

How Humana May Cover Weight Loss Treatment in West Virginia

Important: Humana in West Virginia offers Medicare Advantage (MA) plans. Weight loss benefits for Humana Medicare Advantage members are governed by CMS regulations under 42 CFR Part 422. West Virginia's mental health parity statute (W. Va. Code § 33-25-8r et seq.) applies to mental health and substance use disorder benefits and does not govern weight loss coverage.

Humana Medicare Advantage plans in West Virginia may cover weight loss treatment through:

• Medicare GLP-1 Bridge (July 1, 2026) – eligible MAPD members may access Wegovy, Zepbound, and Foundayo at $50/month via CMS, outside the standard HPS Part D formulary
• HPS Part D pharmacy benefit – Humana Pharmacy Solutions may cover weight loss medications at various formulary tiers with prior authorization; coverage varies by plan
• Provider consultations for weight management – may be covered as preventive or specialist services depending on your plan
• Phentermine and Qsymia – Schedule IV controlled substances; if covered, they are subject to EPCS under W. Va. Code § 60A-4-403a

Prior Authorization: Weight loss medications including GLP-1s typically require prior authorization. Medical necessity criteria generally include BMI ≥30 or BMI ≥27 with a qualifying comorbidity, along with documentation of lifestyle intervention.

Please note: This page describes Humana Medicare Advantage coverage. Medicaid beneficiaries should contact their plan administrator for details.

Frequently Asked Questions

Does Humana cover weight loss treatment in West Virginia?
Humana Medicare Advantage plans in West Virginia may cover weight loss treatment. Notably, eligible MAPD members may access Wegovy, Zepbound, and Foundayo at $50/month through the CMS Medicare GLP-1 Bridge program effective July 1, 2026. HPS Part D pharmacy benefits may also cover weight loss medications with prior authorization. Coverage varies by plan. Verify your benefits with Humana before booking.

Does Humana cover weight loss medication in West Virginia?
Eligible Humana Medicare Advantage members may access Wegovy, Zepbound, and Foundayo at $50/month through the CMS Medicare GLP-1 Bridge (effective July 1, 2026). HPS Part D benefits may also cover weight loss medications. Phentermine and Qsymia (Schedule IV) require EPCS under West Virginia law. Coverage varies by plan. Contact Humana at 1-800-448-6262 or CMS at 1-800-633-4227.

Is Klarity Health in-network with Humana in West Virginia?
Klarity Health works with many insurance plans. To confirm whether Klarity providers are in-network with your specific Humana Medicare Advantage plan in West Virginia, use Klarity's benefits check tool at helloklarity.com or call Humana at 1-800-448-6262.

What is the copay for weight loss treatment with Humana in West Virginia?
The CMS Medicare GLP-1 Bridge provides eligible MAPD members access to Wegovy, Zepbound, and Foundayo at $50/month. Other weight loss medications under the HPS Part D benefit may have different cost-sharing. Verify your specific cost-sharing details with Humana at 1-800-448-6262.

Does Humana require a referral for weight loss treatment in West Virginia?
Referral requirements depend on your specific MA plan type. HMO-based plans may require a primary care referral; PPO-based plans typically allow direct access. Prior authorization requirements for GLP-1 medications are separate from referral requirements. Check your plan documents or call Humana.

Does Humana cover online weight loss treatment in West Virginia?
Humana Medicare Advantage plans may cover telehealth weight loss consultations and medication management in West Virginia. Klarity Health provides online weight loss treatment including GLP-1 medication management. Verify your specific telehealth and weight loss benefits with Humana before scheduling.

How do I verify my Humana coverage for weight loss in West Virginia?
To verify your Humana weight loss coverage: (1) call Humana at 1-800-448-6262, (2) call 1-800-379-0092 (Humana Pharmacy), (3) call CMS at 1-800-633-4227 for Medicare GLP-1 Bridge details, (4) use Klarity's benefits check at helloklarity.com, or (5) contact the West Virginia Insurance Commissioner at 1-888-879-9842.

What Humana plans may cover weight loss medication in West Virginia?
Humana Medicare Advantage MAPD plans in West Virginia may cover weight loss medications through both the CMS Medicare GLP-1 Bridge ($50/month for Wegovy, Zepbound, Foundayo effective July 1, 2026) and the HPS Part D pharmacy benefit. Coverage terms vary by specific plan. Verify your coverage with Humana or CMS.

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. Please verify your specific plan's mental health coverage with your insurer or through Klarity's benefits check before booking.

If you are a Medicaid beneficiary, your coverage may be different from what is described here. Please contact your state Medicaid program or plan administrator for details.

Check if your Humana plan may cover weight loss treatment in West Virginia