The GLP-1 Companion program is a structured framework that determines a member's GLP-1 medication coverage based on their active program engagement. When members meet the required criteria, they become eligible to receive coverage at the pharmacy.
🔄 Program Overview & Key Rules
The "New" GLP-1 Companion applies to clients launching after January 1, 2026. It shifts from a single monthly engagement event to a stricter, multi-metric requirement (similar to Dell's VBID).
| Feature | Details |
|---|---|
| Eligible Programs | Members can participate in various programs, including WL+, MWL, and CWL. |
| Standard Grace Period | 90 days. (Example: 1/1/26 launches must enroll and start engaging before 4/1/26 to ensure their medication is covered). |
| Sutter Exception | Sutter members who are GLP-1 naive must enroll and engage monthly for 6 out of 7 months before they become eligible for a prescription; they also have a 60 day grace period. |
✅ Engagement Requirements
To maintain a "Green" (eligible) status, members must meet ALL THREE of the following requirements within a rolling 4-calendar-week lookback period.
Note: Weeks run Monday through Sunday, and the current week counts in the lookback.
| Requirement Category | Minimum Rule | Agent Guidance |
|---|---|---|
| 1. Provider Interaction | 1 consult or webinar within the last 4 weeks. | Encourage webinars for group program members; encourage 1:1 consults for individual programs. |
| 2. Biometric Tracking | 1 entry per week for at least 3 out of 4 weeks. | Logging any metric counts toward this goal. |
| 3. Self-Paced Learning | 1 unit per week for at least 2 out of 4 weeks. | Completing any lesson, program unit, or screener counts. |
🛠️ Tracking & Troubleshooting
Members track their progress via an in-app tracker. As an agent, your Health Guide (Hermes) and Provider (Delphi) dashboards perfectly mirror the member's view so you can troubleshoot seamlessly.
How to Investigate Status Changes (Green to Red):
Always check which 4 weeks are currently active, identify exactly which requirement failed, and calculate when the member can next achieve eligibility. Statuses typically turn red because a successful week dropped out of the rolling window, a 4-week consult expired, or the 90-day grace period ended.
Common Member Inquiries:
| What the Member Says | How to Investigate & Respond |
|---|---|
| "I tracked today but my tracker is still red." | Confirm the activity was logged before the daily system cutoff time. |
| "I was green yesterday, why am I red now?" | Explain the rolling window. A past week with successful engagement likely just dropped off the 4-week lookback period. |
| "I need my prescription refill today." | Check their current eligibility status and review the specific exception pathway for their plan if they are currently red. |
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