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Wellfleet Rx Student Formulary updates – January 2025

At Wellfleet, we’re committed to providing student-centric health insurance solutions that evolve with the changing needs of our members.

As part of this commitment, we regularly review and update our Student Formulary to ensure it offers the most effective and cost-efficient medications. We’re excited to share the latest Wellfleet Rx Student Formulary updates effective January 2025.1

January 2025 Wellfleet Rx Student Formulary

Expanded Diabetes Management Options

To better serve students managing diabetes, we’ve added two important medications to our formulary:

These additions provide more cost-efficient therapies for our student members to effectively manage their blood sugar levels, supporting their overall health and academic success.

New Biosimilar for Humira

We’re introducing a third biosimilar for Humira (adalimumab), available through Accredo at a significantly discounted plan cost. Also, it will be available at no cost to our members. This addition expands treatment options and helps reduce costs for both students and school plans. Accredo’s expert pharmacists will assist with appropriate conversions, ensuring a smooth transition for affected members.

Weight Management Solutions

We recognize that weight management can be a crucial aspect of student health. For plans that cover weight loss medications, we’ve added two new products:

In addition to providing quality options to student members, both of these medications are dosed weekly rather than daily – helping improve adherence.

These additions reflect our commitment to supporting students’ overall health and well-being.

Expanded HIV Treatment Options

We’ve added four new HIV treatment products to our formulary:

This expansion ensures that students living with HIV have access to a broader range of treatment options, supporting their health and academic pursuits. Further, this update provides a better dosing schedule for students. Now, students have several combination product options that only require 1 pill a day.

Improved Access to Nicotine Replacement Therapy

To help support students who are trying to quit smoking, we’ve removed Step Therapy requirements for nicotine replacement products (gum, lozenge, and patch). We’ve also eliminated the previous restriction of two quit attempts per year for these products, making it easier for students to access these important cessation aids when needed.

Ongoing Generic Medication Emphasis

In our continuing efforts to contain costs while maintaining quality care, we’ve removed several brand-name products from the formulary and replaced them with generic equivalents. This change helps keep premiums affordable while helping ensure students have access to effective medications.

Thoughtful Decisions for Student Wellness

At Wellfleet, we don’t just follow market trends – we make decisions based on what’s best for our student members. Here are some important choices we’ve made with student wellness in mind:

  • Preserving Access to Brand-Name Contraceptives: The industry trend is to move towards coverage of only the cheapest generic birth controls available. Despite potential cost savings, we’ve decided to maintain coverage for brand-name contraceptives. We recognize the importance of these medications and don’t want students to face unnecessary hurdles in accessing their preferred birth control methods.
  • Maintaining Mental Health Medication Coverage: Again, the industry trend is moving towards limited options in this space. Brand name products that have proven efficacy are being pushed out of favor, and older generic products, which may have a poor side effect profile, are becoming the standard. We understand the critical nature of mental health treatments. That’s why we’re not making changes to brand-name mental health products, ensuring students can continue their current treatments without disruption.
  • Expanding Weight Loss Medication Coverage: While some in the market are restricting weight loss coverage entirely under their plans, Wellfleet is taking a different approach. For our select plans that include weight loss medications, we’re expanding coverage to include Wegovy and Zepbound and updating prior authorization criteria to require documentation to ensure alignment with FDA requirements. Our prior authorization criteria will now require documentation of the students’ body mass index (BMI), which must be in alignment with the requirements set by the FDA prior to approval. This ensures appropriate usage while increasing access for students needing these products.

Our Commitment to Student Health

These Wellfleet Rx Student Formulary updates reflect our ongoing commitment to providing comprehensive, affordable, and accessible healthcare coverage for students.

We understand that each student’s health needs are unique, and we strive to offer a range of options that support their well-being and academic success.

For more information about these updates, click here, or you can find the complete January 2025 Wellfleet Rx Formulary here.

We’ll continue to innovate and adapt our offerings to meet the evolving needs of the students we serve. Connect with our team to learn more about our student-centric health insurance plans and our Student Formulary, which includes 50+ medications with a $0.00 copay.  

Disclaimers

1 State laws in Colorado, Connecticut, Louisiana, New York, and Texas require our plan to cover medications at the same benefit level until the plan year ends. This means that if a medication covered under our formulary at the start of the plan year is taken off the formulary, is changed to a different cost-share tier, or has new utilization management requirements, these changes will not go into effect until the next plan year. For members of a plan in Colorado, Connecticut, Louisiana, New York, or Texas, this document will not be applicable until the plan is renewed in or after January 2025. Please reference the applicable July 2024 Wellfleet Rx Student Formulary on https://wellfleetrx.com/students/formularies/ for your current benefits. 

Wellfleet, Wellfleet Student, Wellfleet Special Risk, and Wellfleet Workplace are marketing names used to refer to the insurance and administrative operations of Wellfleet Insurance Company, Wellfleet New York Insurance Company, and Wellfleet Group, LLC (known in California only as Wellfleet Group, LLC dba Wellfleet Administrators, LLC). All insurance products are administered or managed by Wellfleet Group, LLC. Product availability is based upon business and/or regulatory approval and may differ among states. ©2024 Wellfleet Group, LLC. All Rights Reserved.

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©2025 Wellfleet Group, LLC. All Rights Reserved.

Wellfleet is the marketing name used to refer to the insurance and administrative operations of Wellfleet Insurance Company, Wellfleet New York Insurance Company, and Wellfleet Group, LLC. All insurance products are administered or managed by Wellfleet Group, LLC. Product availability is based upon business and/or regulatory approval and may differ among companies.