Educational insurance policy reference. Not medical, legal, or individualized coverage advice.
The Kansas State Employee Health Plan requires CVS Caremark prior authorization for every anti-obesity medication it covers. For weight-management GLP-1 prescriptions or prior authorizations issued or renewed on or after January 1, 2026, the published rule sets a floor of BMI 35 or higher. Wegovy is the preferred GLP-1; Zepbound is non-preferred unless a preferred product was tried and failed or cannot be used for medical reasons.
Kansas also closed the continuation-rule conflict that had appeared in its earlier public records. On May 11, 2026, the Kansas State Employees Health Care Commission adopted a BMI 35 baseline for initial treatment and ongoing therapy and eliminated the separate 5% weight-loss continuation option.
Here is the part the plan's member pages do not assemble in one place: Kansas recorded 8,409 GLP-1 prior authorizations in 2024 — 35.1% of all 23,927 prior authorizations that year — and 7,455 were for weight loss. The older BMI-and-response rules also produced a clean arithmetic breakpoint: a member had to start at BMI 36.85 to lose 5% and still finish at 35. That number explains the conflict Kansas later removed; it is not a current alternative coverage rule.
| Field | Answer |
|---|---|
| Plan | Kansas State Employee Health Plan (SEHP) |
| Prior authorization administrator | CVS Caremark |
| Anti-obesity medications | Prior authorization required |
| Weight-management BMI threshold | 35 or higher |
| Current treatment-stage rule | BMI 35 applies to initial treatment and ongoing therapy |
| Original effective date | January 1, 2026 |
| Ongoing-therapy clarification adopted | May 11, 2026 |
| Preferred GLP-1 | Wegovy |
| Non-preferred GLP-1 | Zepbound; clinical exception route stated by the plan |
| Grandfathering under the 2025 motion | None; current users were not grandfathered |
| 2024 GLP-1 share of all prior authorizations | 35.1%: 8,409 of 23,927 |
| 2024 weight-loss GLP-1 share of all prior authorizations | 31.2%: 7,455 of 23,927 |
| Historical BMI needed to lose 5% and remain at 35 | 36.85 |
| Last verified | July 31, 2026 |
Primary sources: Kansas SEHP GLP-1 page; Plan Year 2026 Active Enrollment Guide; June 3, 2025 HCC minutes; May 11, 2026 HCC booklet; June 17, 2025 HCC meeting booklet. Derived percentages are shown in the methodology below. Retrieved July 31, 2026.
What this is. This is an audit of public plan documents, not a live claims result. Whether an individual request is approved depends on the member's benefit, indication, documentation, formulary status, and Caremark's review. This page is educational and is not medical, legal, or insurance advice.
Answer: All anti-obesity medications require prior authorization through CVS Caremark. For GLP-1 treatment used for weight management, Kansas publishes a BMI floor of 35 or higher, requires the prescribed drug to be covered on the SEHP Preferred Drug List, and now applies the BMI floor to both initial treatment and ongoing therapy.
Two current member-facing documents describe the January 1, 2026 rule with slightly different nouns. The SEHP's GLP-1 page applies it to weight-management GLP-1 prescriptions issued or renewed after January 1, 2026. The Plan Year 2026 enrollment guide applies it to prior authorizations issued or renewed on or after January 1, 2026.
The later Commission record supplies the treatment-stage answer that those pages once left muddy. On May 11, 2026, the Commission adopted the BMI 35 baseline for all GLP-1 anti-obesity-medication use and directed that it apply to initial treatment and ongoing therapy.
| Request path | Prior authorization | BMI or clinical gate | Product status | Step or exception rule | Evidence class |
|---|---|---|---|---|---|
| Initial Wegovy for weight management | Required, through Caremark | BMI 35+ | Preferred GLP-1 for weight management | No preferred-product prerequisite is publicly stated for the preferred product | Current plan rule |
| Initial Zepbound for weight management | Required, through Caremark | BMI 35+ | Non-preferred | Preferred product previously tried and failed, or cannot be used for medical reasons; the prescriber may submit supporting documentation for an exception | Current plan rule |
| Ongoing weight-management GLP-1 therapy | Review applies at renewal | BMI 35+ applies to ongoing therapy | Requested drug must remain covered under the current plan design | Drug-specific preference and exception rules still apply | Adopted current policy |
| Former response-based continuation route | Historical continuation review | At least three months at a stable dose, then at least 5% loss from baseline weight or maintenance of that loss | Drug-specific | Eliminated as a separate continuation option on May 11, 2026 | Superseded official criterion |
| GLP-1 prescribed for diabetes or another approved condition | Condition-specific | The public BMI 35 statement is for weight management and does not automatically control another indication | Condition- and formulary-specific | Caremark maintains criteria by medical condition | Current plan scope distinction |
Source: The RX Index Kansas SEHP GLP-1 Public-Record Requirements Dataset, version 2026.07.31. Compiled from the current SEHP GLP-1 page, Plan Year 2026 guide, February 21, 2025 HCC packet, May 11, 2026 HCC booklet, and June 2, 2026 HCC booklet. Retrieved July 31, 2026.
Answer: Kansas replaced the old public-record conflict with one plan-level rule. The Commission adopted BMI 35 or higher as the baseline for all GLP-1 anti-obesity-medication use, applied it to initial treatment and ongoing therapy, and eliminated the separate 5% weight-loss continuation option.
The timing matters. The January 1, 2026 member-facing rule already said BMI 35 applied when a prescription or prior authorization was issued or renewed. Older Caremark continuation material in the Kansas record separately described approval after at least three months at a stable dose when the member had lost at least 5% of baseline weight or maintained that loss.
Those tests could point in opposite directions. A member could meet the response standard precisely by falling below the BMI floor. Kansas officials discussed that problem in February and April 2026, then the Commission resolved the policy-level conflict in May.
| Public-policy stage | BMI rule | Response rule | What the record meant |
|---|---|---|---|
| January 1 – May 10, 2026 | BMI 35 stated for prescriptions or prior authorizations issued or renewed | Official records also referenced 5% loss from baseline or maintenance after stable-dose therapy | Two public criteria existed without a published hierarchy |
| May 11, 2026 Commission action | BMI 35 baseline for all GLP-1 AOM use | Separate 5% continuation option eliminated | BMI rule expressly applied to initial and ongoing therapy |
| Current public-policy position as of July 31, 2026 | BMI 35 for initial treatment and ongoing therapy | No separate 5% pathway in the adopted May rule | The policy-level conflict is resolved; live claims mechanics remain plan-administered |
Primary sources: February 6, 2026 HCC minutes; April 15, 2026 HCC packet; May 11, 2026 HCC booklet; June 2, 2026 HCC booklet; June 2, 2026 meeting transcript. Retrieved July 31, 2026.
The adopted policy does not publish every claims-system detail. The public record still does not show the exact field Caremark uses for the BMI measurement, the measurement date it accepts, the current authorization duration, or the full submission checklist. Those are operational questions, not a reason to revive the eliminated 5% route.
Answer: With height unchanged, a 5% reduction in body weight produces a 5% reduction in BMI. Under the two older public criteria, a member needed a starting BMI of at least 36.8421 — 36.85 rounded upward to two decimals — to lose 5% and still finish at a BMI of 35.
The formula:
minimum starting BMI = required ending BMI ÷ (1 − required weight-loss fraction)
= 35 ÷ 0.95
= 36.842105…
This remains a useful finding because it measures the conflict Kansas officials were trying to solve. It is not a clinical threshold, it is not a separate eligibility route, and it is not the current continuation rule.
| Starting BMI | BMI after 5% loss | At or above 35? | BMI after 10% loss | At or above 35? |
|---|---|---|---|---|
| 35.00 | 33.25 | No | 31.50 | No |
| 35.50 | 33.73 | No | 31.95 | No |
| 36.00 | 34.20 | No | 32.40 | No |
| 36.50 | 34.68 | No | 32.85 | No |
| 36.84 | 34.998 | No under exact arithmetic | 33.16 | No |
| 36.85 | 35.01 | Yes | 33.17 | No |
| 37.00 | 35.15 | Yes | 33.30 | No |
| 38.00 | 36.10 | Yes | 34.20 | No |
| 40.00 | 38.00 | Yes | 36.00 | Yes |
Source: The RX Index Kansas SEHP GLP-1 Public-Record Requirements Dataset, version 2026.07.31. Calculated as starting BMI × (1 − weight-loss fraction). Display values are rounded to two decimals except the 36.84 row, where 34.998 is shown to prevent rounding from changing the yes/no result.
| If the member loses | Minimum starting BMI under the old two-rule interaction |
|---|---|
| 5% | 36.85 |
| 10% | 38.89 |
| 15% | 41.18 |
| 20% | 43.75 |
Source: The RX Index Kansas SEHP GLP-1 Public-Record Requirements Dataset, version 2026.07.31. Calculated as 35 ÷ (1 − weight-loss fraction), then rounded upward to two decimal places.
Read the table for what it is: a reproducible explanation of the former conflict. A starting BMI of 40 followed by a 20% loss produces a BMI of 32. That showed why a hard current-BMI floor and a response-based continuation test could not coexist cleanly without a hierarchy. Kansas's May 11 action chose the BMI rule for ongoing therapy and removed the separate 5% continuation option.
Answer: The Commission first adopted the BMI 35 restriction on June 3, 2025, with a January 1, 2026 effective date and no grandfathering for current users. After implementation exposed the continuation conflict, the Commission revised the policy on May 11, 2026 by applying BMI 35 to initial and ongoing therapy and eliminating the separate 5% continuation route.
The June 3, 2025 motion passed by unanimous roll call. The minutes recording it were later included in the August 20, 2025 meeting packet, which is why a searcher can easily mistake the publication date for the adoption date.
The no-grandfathering language matters. It shows that the original motion was intended to reach existing users rather than protect them indefinitely under the previous standard. The May 2026 action then made the ongoing-therapy rule explicit.
| Date | Public-record event | Why it matters | Evidence class |
|---|---|---|---|
| Dec. 10, 2024 | HCC materials report $9.2M in net GLP-1 plan spend for January–September 2024 and $1.4M across 3,100 prescriptions in October | Establishes the first cost snapshot used in this dataset | Official meeting record |
| Feb. 21, 2025 | HCC materials report 3,444 unique anti-obesity GLP-1 utilizers in 2024 and $8.1M in net cost for Wegovy and Zepbound; the 5% continuation criterion appears in the record | Establishes the AOM-specific benchmark and historical response rule | Official meeting record |
| June 3, 2025 | HCC adopts BMI 35+ for weight-loss GLP-1 coverage beginning Jan. 1, 2026; current users are not grandfathered; motion passes by unanimous roll call | Original adoption point | Adopted policy |
| June 17, 2025 | HCC materials publish prior-authorization counts, GLP-1 request counts, appeal counts, paid review amounts, and PBM bid pricing; the Commission also addresses the 2026–2028 PBM contract | Source of the original PA dataset and fee analysis | Official meeting and procurement record |
| Aug. 20, 2025 | Packet publishes the June 3 minutes | Publication location of the adoption record | Official meeting record |
| Oct. 1, 2025 | Plan Year 2026 guide states BMI 35+ for prior authorizations issued or renewed on or after Jan. 1, 2026 | Member-facing operational wording | Current plan document |
| Jan. 1, 2026 | BMI 35 rule takes effect | Start of the current plan-year threshold | Current plan rule |
| Feb. 6, 2026 | HCC discusses the conflict between BMI 35 at renewal and continuation after successful weight loss | Public recognition of the rule interaction | Policy discussion |
| Apr. 15, 2026 | HCC materials present the option to apply BMI 35 to initial and ongoing therapy and remove the 5% continuation option | Proposal that became the May action | Policy proposal |
| May 11, 2026 | HCC adopts BMI 35 as the baseline for all GLP-1 AOM use, applies it to initial and ongoing therapy, and eliminates the 5% continuation option | Current continuation-policy decision | Adopted policy |
| June 2, 2026 | HCC records memorialize the May action; the meeting transcript reports $11.85M in 2025 GLP-1 spending | Latest annual spending figure located and confirmation of current policy | Official meeting record |
| July 31, 2026 | The RX Index dataset verified | Version anchor | Dataset release |
Primary sources: December 10, 2024 HCC packet; February 21, 2025 HCC packet; June 3, 2025 HCC minutes; June 17, 2025 HCC meeting booklet; August 20, 2025 HCC packet; Plan Year 2026 guide; February 6, 2026 HCC minutes; April 15, 2026 HCC packet; May 11, 2026 HCC booklet; June 2, 2026 HCC booklet; June 2, 2026 transcript. Retrieved July 31, 2026.
Answer: Kansas currently identifies Wegovy as the preferred GLP-1 for weight management and Zepbound as non-preferred. The public plan page states that Zepbound may be considered when a preferred product was tried and failed or cannot be used for medical reasons, but the public documents do not establish one universal dollar cost for every member.
The distinction is clinical and formulary-specific:
The public sources do not support mapping Kansas's "preferred" and "non-preferred" labels to one universal 35% versus 60% coinsurance result for Zepbound. Kansas directs members to the Caremark Check Drug Cost tool because the estimated amount depends on the specific medication and selected plan.
CVS Caremark has separately announced that it plans to add Zepbound as an additional preferred option on commercial formularies on October 1, 2026 for plan sponsors that elect the option. That announcement does not change Kansas's current page ahead of Kansas's own adoption or update. As of July 31, 2026, the Kansas page still identifies Wegovy as preferred and Zepbound as non-preferred.
Primary sources: Kansas SEHP GLP-1 page; Q1 2026 Kansas Preferred Drug List; Kansas CVS Caremark benefit page; CVS Caremark formulary announcement. Retrieved July 31, 2026.
Answer: Kansas SEHP recorded 23,927 prior authorizations in 2024. Of those, 8,409 were for GLP-1s and 7,455 were for weight loss, making GLP-1s 35.1% of all prior authorizations and weight-loss GLP-1s 31.2%.
Kansas published the counts in follow-up materials for the June 17, 2025 Health Care Commission meeting. The figures cover the plan's recorded pharmacy prior-authorization and review activity; they do not publish approval and denial outcomes by GLP-1 indication.
| Year | Prior authorizations | Level 1 appeals | Level 2 appeals | Urgent reviews | External reviews |
|---|---|---|---|---|---|
| 2022 | 11,573 | 216 | 25 | 154 | 13 |
| 2023 | 13,576 | 260 | 16 | 154 | 9 |
| 2024 | 23,927 | 1,143 | 83 | 199 | 25 |
| 2025 through May | 9,875 | 328 | 17 | 69 | 7 |
Primary source: Kansas HCC meeting materials, June 17, 2025. Retrieved July 31, 2026.
What falls out of the table, with the arithmetic kept visible:
The plan reported paying $815,885 in 2024 for prior authorizations, appeals, and reviews combined. Across the 25,377 recorded events in those five columns, that is a derived blended paid amount of approximately $32.15 per recorded event.
That $32.15 figure is not the contractual price of a standard prior authorization. It blends several review types with different proposed fee schedules and may not capture every accounting adjustment. It is useful as a transparent division of the plan's reported total by its reported event count, and nothing more.
Caremark's winning 2025 proposal listed $45 per prior-authorization coverage review, with separate prices for appeal categories. In the meeting record, Caremark also said a denied prior authorization and a case closed with no response result in a charge because review work occurred.
Applying the proposed $45 rate to the prior year's counts produces this illustration:
| Measure | 2024 count | Count × $45 |
|---|---|---|
| All prior authorizations | 23,927 | $1,076,715 |
| GLP-1 prior authorizations | 8,409 | $378,405 |
| Weight-loss GLP-1 prior authorizations | 7,455 | $335,475 |
Source: The RX Index Kansas SEHP GLP-1 Public-Record Requirements Dataset, version 2026.07.31. Counts and proposal pricing come from the June 17, 2025 HCC meeting booklet. This is illustrative arithmetic, not an invoice or a claim about the amount Kansas ultimately paid under the 2026 contract.
The public data do not show how many GLP-1 requests were approved or denied, how many denials resulted specifically from BMI 35, or whether the May 2026 continuation change increased any outcome. That means the fee schedule can be described, but it cannot be turned into a causal claim about the new BMI rule.
Commissioner Vicki Schmidt's recorded dissent stated that Caremark had increased its per-authorization fee by 50% without prior notice to the Commission. Caremark also told the Commission that utilization management saved the plan $26.7 million in 2024. Both statements belong in the record; the public materials reviewed do not provide a full underlying calculation that independently reconciles either figure.
Answer: Kansas SEHP reported $9.2 million in net GLP-1 plan spend for January through September 2024 and $11.85 million in total GLP-1 spending for calendar 2025. It separately reported 3,444 unique anti-obesity GLP-1 users in 2024 and $8.1 million in net cost for Wegovy and Zepbound.
These are valid snapshots with different scopes. All-GLP-1 spending includes drugs and indications that are not identical to the Wegovy-and-Zepbound weight-management subset, so the figures should not be chained into one growth rate.
| Period | Measure | Value | Scope stated in the source |
|---|---|---|---|
| Jan.–Sep. 2024 | Net plan spend | $9.2M | All GLP-1 drugs |
| Oct. 2024 | Net plan spend | $1.4M | All GLP-1 drugs |
| Oct. 2024 | Prescriptions | 3,100 | All GLP-1 drugs |
| Oct. 2024 | Derived net plan spend per reported prescription | $451.61 | $1.4M ÷ 3,100 |
| Calendar 2024 | Unique utilizers | 3,444 | GLP-1 anti-obesity medications |
| Calendar 2024 | Net cost | $8.1M | Wegovy and Zepbound |
| Calendar 2024 | Weight-loss GLP-1 prior authorizations | 7,455 | Weight-loss indication |
| Calendar 2025 | Reported spending | $11.85M | All GLP-1 medications |
Primary sources: December 10, 2024 HCC packet; February 21, 2025 HCC packet and transcript; June 17, 2025 HCC meeting booklet; June 2, 2026 meeting transcript. Retrieved July 31, 2026.
The cleanest derived spending statistic is this:
Based on Kansas SEHP's reported October 2024 figures, net plan spending averaged approximately $451.61 per reported GLP-1 prescription that month.
That is $1.4 million divided by 3,100 prescriptions. It is not a member copay, a retail price, a monthly cost for one drug, a per-person figure, or a forecast. It is one month's reported net plan spend divided by that month's reported prescription count.
The 7,455 weight-loss GLP-1 prior authorizations and 3,444 unique anti-obesity-medication users come from different records and may not cover identical populations, drugs, or timing. Dividing them would produce roughly 2.2, but that result is not a publishable per-user rate without a matched denominator, so it is not used here.
Answer: Kansas keeps weight-management GLP-1 coverage but uses a direct BMI 35 gate for initial and ongoing therapy. Other state plans in this verified snapshot use different levers: mandatory prescribing programs, participation requirements, large stand-alone copays, indication limits, or full exclusions.
For adult chronic weight management, FDA labeling for Wegovy and Zepbound starts at BMI 30 or higher, or BMI 27 or higher with at least one weight-related condition. Kansas's BMI 35 plan threshold is therefore more restrictive than the labeled adult initiation threshold. That comparison is about plan eligibility, not medical appropriateness.
| State plan | Weight-management GLP-1 position | Main access lever | Effective or current date |
|---|---|---|---|
| Kansas SEHP | Covered under plan criteria | BMI 35+ for initial and ongoing therapy; PA; preferred-product rule | Jan. 1, 2026; ongoing rule adopted May 11, 2026 |
| Connecticut state plan | Covered through designated programs | Weight-loss prescriptions covered only through FlyteHealth or Connecticut Children's providers; adult FlyteHealth eligibility is BMI 30+, or 27+ with a related condition; $12.50 monthly program fee | Prescribing gate since July 1, 2023; current fee structure in effect |
| Georgia SHBP | Covered for eligible Anthem and UnitedHealthcare members through the designated program | 9amHealth is mandatory for new weight-loss prescriptions and for current users when the existing PA expires; Kaiser members are excluded from this program | Current 2026 program |
| Wyoming EGI | Covered under expanded program | CVS weight-management-program participation plus PA; prior six-month lifetime limit removed | Jan. 1, 2026 |
| Delaware GHIP | Covered with high stand-alone member cost | $200 per 30-day supply for weight-management GLP-1s; excluded from the prescription out-of-pocket maximum | July 1, 2026 |
| Colorado state employee plans | Covered for members who meet plan criteria | Coverage restored after the earlier 2025 restriction | May 1, 2026 |
| Massachusetts GIC | Not covered for obesity alone; some other approved-condition pathways remain | Indication gate | July 1, 2026 |
| Indiana state employee plan | Not covered for weight loss | Benefit exclusion | Jan. 1, 2026 |
| North Carolina State Health Plan | Not covered for weight loss | Benefit exclusion with no grandfathering under the 2024 decision | Apr. 1, 2024 |
Primary sources: Kansas SEHP; Connecticut Care Compass; Georgia SHBP; Wyoming EGI; Delaware weight-loss medication FAQ; Colorado coverage-change FAQ; Massachusetts GIC update; Indiana prescription coverage; North Carolina coverage-exclusion record; FDA Zepbound approval; FDA Wegovy prescribing information. This is a selected comparison, not a fifty-state census. Retrieved July 31, 2026.
Within this selected set, Kansas is notable for putting the restriction directly into the BMI criterion. That does not prove Kansas is the only state plan in the country using a higher BMI threshold; this table is not broad enough to support that claim.
North Carolina's State Health Plan published a utilization-management options table showing that several departures from FDA-labeled criteria — including a proposed BMI 40 threshold or BMI 35 with a related condition — were expected to cause a 100% loss of GLP-1 rebates under that plan's arrangement. The same document did not say every possible program had that result: its CVS Weight Loss Program row described an opportunity to earn and keep rebates, with details still to be worked out.
Kansas adopted BMI 35 and later renewed its Caremark relationship, but the Kansas records reviewed for this page do not publish the rebate effect attributable to that threshold. The defensible conclusion is narrow: two public plans working with CVS Caremark published materially different records about how tighter access rules could interact with rebates. The public documents do not establish why.
Primary sources: North Carolina utilization-management options; North Carolina CVS contract fact sheet; Kansas June 17, 2025 HCC meeting booklet. Retrieved July 31, 2026.
Answer: We assembled the current Kansas member-facing rule, the adoption and revision record, the prior-authorization counts, the spending figures, and the selected state-plan comparison into one versioned dataset. Every consequential field is tied to a primary source, an evidence class, a source date, and a verification date; every derived number shows its formula.
This dataset covers publicly available Kansas SEHP rules and records for GLP-1 and other anti-obesity-medication access, with emphasis on weight-management prior authorization. It uses 2022–2026 records for volume and policy history, and treats July 31, 2026 as the current-policy verification date.
Each rule row represents a distinct public-policy path or evidence state: initial preferred-product treatment, initial non-preferred treatment, ongoing therapy, a superseded continuation criterion, or another medical indication. The rows do not represent members, approvals, denials, or clinical outcomes.
The later authoritative source controls. A May 2026 adopted action supersedes a February 2025 criterion when the two address the same continuation pathway. A proposal is never coded as adopted. Missing public information is labeled not publicly verified, not silently converted into "not required." A generic Caremark criterion is not substituted for a Kansas-specific adopted rule.
BMI after weight loss = starting BMI × (1 − weight-loss fraction) Minimum starting BMI = required ending BMI ÷ (1 − weight-loss fraction) Average spend per Rx = reported net plan spend ÷ reported prescription count Share of prior auths = category prior authorizations ÷ total prior authorizations Change over time = (later count − earlier count) ÷ earlier count Blended paid amount/event = reported paid amount ÷ total recorded review events Illustrative PA fee amount = recorded PA count × proposed per-review fee
| Source | Source date | What it supports | Evidence treatment |
|---|---|---|---|
| SEHP GLP-1 page | Current as verified July 31, 2026 | PA requirement, BMI 35, PDL requirement, Wegovy preference, Zepbound exception, condition-specific criteria | Current rule |
| Plan Year 2026 Active Enrollment Guide | Plan year 2026 | PA issued-or-renewed wording and Jan. 1, 2026 date | Current plan document |
| Q1 2026 Preferred Drug List | Jan. 1, 2026 | Current-quarter formulary context | Current plan document |
| June 3, 2025 HCC minutes | June 3, 2025 | Original BMI 35 adoption, Jan. 1 effective date, no grandfathering, vote | Adopted policy |
| June 17, 2025 HCC booklet | June 17, 2025 | PA, appeal and review counts; GLP-1 counts; paid amount; proposal fees; PBM record | Official meeting/procurement record |
| February 21, 2025 HCC packet | Feb. 21, 2025 | 2024 AOM utilization/cost and former continuation criterion | Official historical record |
| December 10, 2024 HCC packet | Dec. 10, 2024 | 2024 GLP-1 net-spend and prescription snapshot | Official meeting record |
| February 6, 2026 HCC minutes | Feb. 6, 2026 | Public discussion of ongoing-therapy conflict | Policy discussion |
| April 15, 2026 HCC packet | Apr. 15, 2026 | Proposed resolution of BMI/5% conflict | Policy proposal |
| May 11, 2026 HCC booklet | May 11, 2026 | BMI 35 for all GLP-1 AOM use, initial and ongoing therapy, elimination of 5% option | Adopted current policy |
| June 2, 2026 HCC booklet and transcript | June 2, 2026 | May-action record and 2025 spending statement | Official meeting record |
Source: The RX Index Kansas SEHP GLP-1 Public-Record Requirements Dataset, version 2026.07.31. Retrieved July 31, 2026.
The current-rule fields were checked against the SEHP's current GLP-1 page and Plan Year 2026 materials on July 31, 2026. Historical records are kept under their original dates and are not allowed to override the later May 11, 2026 action. A material change to the BMI rule, preferred product, exception route, PDL, or ongoing-therapy policy requires a new verification date and dataset version.
Answer: This is a record of public policy and reported plan data, not the live Caremark claims system. It cannot tell a member whether a particular request will be approved, what a particular prescription will cost, why a particular claim was denied, or which exact fields a prescriber will see during submission.
The public sources reviewed do not establish:
The May 11 action resolves the public policy hierarchy between BMI 35 and the former 5% route. It does not expose every operational field Caremark uses to implement that policy.
Answer: The strongest current rules are clear, but the operational record remains fragmented across member pages, guides, Commission minutes, packets, and transcripts. The dataset keeps those evidence classes separate so an old criterion, a proposal, and a current rule do not get blended into one answer.
Answer: Use the dataset version and verification date so the cited finding can be traced to the exact Kansas policy snapshot. The format below is neutral attribution information, not a request for a citation.
The RX Index Editorial Team. "State Employee Health Plan GLP-1 Prior Authorization Requirements: Kansas SEHP 2026." The RX Index Research. Dataset version 2026.07.31. Last verified July 31, 2026. https://therxindex.com/research/state-employee-health-plan-glp-1-prior-authorization-requirements/ Accessed [Month Day, Year].
Source: The RX Index Kansas SEHP GLP-1 Public-Record Requirements Dataset, version 2026.07.31.
Yes. Kansas SEHP states that all anti-obesity medications require prior authorization through CVS Caremark. Wegovy is the current preferred GLP-1 for weight management, but preferred status does not remove the BMI 35 requirement or the review.
BMI 35 or higher. The plan's current page and Plan Year 2026 guide apply the threshold to prescriptions or prior authorizations issued or renewed on or after January 1, 2026, and the May 11, 2026 Commission action applies it to initial and ongoing therapy.
The Commission adopted BMI 35 as the baseline for all GLP-1 anti-obesity-medication use, applied it to initial treatment and ongoing therapy, and eliminated the separate 5% weight-loss continuation option. That superseded the older public-record conflict described earlier on this page.
Zepbound is currently non-preferred under the Kansas plan page. The page states that the member must have tried and failed a preferred product or be unable to use it for medical reasons, after which the prescriber may submit documentation to Caremark for an exception review.
Not automatically. Kansas publishes BMI 35 as a weight-management criterion and states that Caremark has separate prior-authorization criteria for each approved medical condition. A diabetes request must be evaluated under the applicable condition-specific and formulary rules.
The current public policy applies BMI 35 to ongoing therapy. The public documents do not show the exact measurement timing, form field, or claims-system workflow Caremark uses, so a member facing renewal should request the current criteria in writing. The 36.85 calculation on this page describes the former rule conflict; it is not a current exception.
No. The June 3, 2025 motion states that current members using GLP-1s would not be grandfathered when the BMI 35 restriction took effect.
It was adopted June 3, 2025, took effect January 1, 2026, and was revised on May 11, 2026 to apply BMI 35 to initial and ongoing therapy while eliminating the separate 5% continuation option.
In 2024, 8,409 of the plan's 23,927 prior authorizations were for GLP-1s, and 7,455 were for weight loss. Those equal 35.1% and 31.2% of all prior authorizations, respectively.
The plan reported $9.2 million in net GLP-1 plan spend for January through September 2024 and $11.85 million in all-GLP-1 spending for calendar 2025. It separately reported $8.1 million in 2024 net cost for Wegovy and Zepbound across 3,444 unique anti-obesity-medication users.
2026-07-31 — v2026.07.31 — Initial publication. Current policy incorporates the May 11, 2026 HCC action applying BMI 35 to initial and ongoing therapy and eliminating the former 5% continuation option. Source ledger covers 11 primary documents spanning December 2024 through July 2026.