Did TRS change its benefits for weight loss treatment?
TRS did not change its benefits. As indicated in your plan benefit booklet, TRS has always excluded benefits for weight loss treatments.
TRS recently became aware through claims oversight that doctors were prescribing these drugs for weight loss and anti-obesity. It was never TRS' intent to cover weight loss and anti-obesity drugs as a health insurance benefit.
TRS actively monitors all claims for inappropriate spending patterns. We make corrections as necessary. Monitoring claims saves health plans millions of dollars, so we don't have to pass those costs to participants.
While TRS paid for some anti-obesity medications, these claims should not have been covered.
Refer to your plan's benefits booklets for more information about coverage:
TRS-ActiveCare Primary and Primary+
Does TRS cover weight loss drugs under any circumstance?
No. We do provide coverage for anti-diabetics that may cause weight loss as a side effect. But we do not cover medication for weight loss as the main purpose.
What weight loss and anti-obesity drugs does TRS exclude?
TRS excludes drugs prescribed and dispensed for the treatment of obesity, with an FDA indication for weight loss, weight reduction, or dietary control.
This is true even if the participant has medical conditions which might benefit from weight loss — even if prescribed by a physician or other provider (examples: Saxenda, Wegovy). TRS covers this class of drugs for diabetes, but not weight loss.
Why does TRS exclude weight loss treatment?
TRS provides health care to nearly three quarters of a million Texans who pay premiums into the TRS health plans. We're responsible for containing health care costs for these participants. As such, we cannot cover every service.
It is not common for large, public health plans to cover weight loss drugs. TRS is not unique in excluding such drugs from its health plan.
What weight loss benefits does TRS offer?
TRS offers fitness programs, nutrition counseling and gym memberships. Although TRS does not offer weight loss drugs, we encourage members to consult with their doctor on alternatives to weight loss medications.
TRS offers Health and Well-being weight loss options through its value-added benefits. These are available at no extra cost:
- online fitness programs
- discounted gym memberships
- obesity counseling
- one-on-one health coaching
- nutrition counseling
For those who qualify, TRS does cover bariatric surgery for members enrolled in the Primary and Primary+ plans.
Learn more about your plan wellness benefit:
TRS-ActiveCare TRS-Care Standard TRS-Care Medicare
What is the difference between the Health and Well-being weight loss options and weight loss treatment?
The Health and Well-being weight loss options help participants lose weight without drugs. Weight loss treatment can include prescription drugs for weight loss.
TRS offers a variety of Health and Well-being weight loss options to its participants including a fitness program and Live Well with Well onTarget. TRS does not cover weight loss drugs.
What should I do if I want to take weight loss drugs?
If you cannot pay for the weight loss drugs yourself, consult with your doctor on alternatives to weight loss drugs. All TRS health plans come with extensive benefits to address weight issues, most at no extra cost, to participants.
Learn more about your plan wellness benefit: