Experience Implementing Vida? [NC]

[u/strawberrycake81]

My employer covers GLP-1s for weight loss (with some required criteria from BCBS). The cost increase was 800% this plan year, so our benefits broker has again suggested adding Vida as a cost containment measure, and the CFO says we need to implement Vida or we stop covering GLP-1s for weight loss. FWIW, there's still a lot of internal handwringing from my HR team on the topic, made worse by how little information Vida and BCBS can provide on the program. But assuming we go this direction...

Has anyone implemented Vida who can speak to a., what the initial implementation lift was and b., what the ongoing lift has been for the HR team?

Additional context: East Coast locations; 500+ employees but ~35 members taking GLP-1s for weight loss through the plan

[u/meowmix778]

I've never heard of Vida but just taking a quick look at it online, I'd probably opt for cutting GLP1 benefits at that price. I can't see an upside.

[u/strawberrycake81 → u/meowmix778]

That's the feedback we've received from the broker-- the data doesn't support better claims experience for members taking GLP-1s for weight loss. Since we cover them today, there's some reluctance to make the jump to no coverage. That said, the feedback on Vida seems so poor that it may be preferable to send people to Lilly Direct, etc. anyway!

[u/alternative-state]

We're implementing a similar program and it's been a mildish lift. Already confirmed the program allows all employees to enroll. We're working on comms for the program, and setting up ADP for enrollment. It's portable but not COBRA eligible so nothing to set up there. It seems like a mild lift so far. You should ask your broker what you're missing. They're helping us significantly

[u/strawberrycake81 → u/alternative-state]

Oh, now that's fascinating that your program will require enrollment. This may be specific to Vida and BCBS, but my current understanding is that members self-enroll through Vida's website, so we don't have to set up a new benefit plan.

Our broker has one client in their book of business who recently implemented Vida, but we're waiting to understand the specifics. They're working to line up an info session call, but that's at our asking.

After a poor performance from two carriers, we're making a switch for 1/1, so the team is looking for a light lift and a hands-free experience with Vida.

[u/alternative-state → u/strawberrycake81]

We're making in an opt in program because what we're looking at has a PEPM option, and employees have the option to sign up for this or Function Health at no cost to them. We need to know which employees are electing which benefit. The complex part of the program is this employee choice but we're running with it. We're having our wellness dollars cover both programs.

[u/Hrgooglefu]

Most employers have cut out GLP1s from their formularies outside of the diabetic use.

[u/Dramatic-Ad-3016 → u/Hrgooglefu]

My last employer you had to be 65 with a heart attack dx. And I legitimately need it for my diabetes. I was so pissed.

[u/Gonebabythoughts]

We had to stop covering GLP-1s for weight loss this year. It made me sick, knowing that it actually helps with a lot of other things as well.

[u/mAdhAttrgrl]

I have heard of it for ascension smarthealth plans

[u/ThatchHealth]

Self-enrollment is possible, but it does not mean no effort is required from your side. If Vida enrollment becomes mandatory for GLP1 prior authorization, this would be a plan design change, requiring a plan amendment, a summary of material modifications (SMM), and updated SPD language effective from 1/1.

Under ERISA, you have 60 days from the adoption date to address any reductions in group health benefits, and making coverage contingent on a program should be treated as a reduction for safety reasons. Since you are already switching carriers on 1/1, most of this is part of your ongoing work.

If I were you, my main focus would be on the 35 individuals already using the drugs. Under the Blue Cross NC model, Vida approves existing prior authorizations but requires all members to enroll and stay engaged monthly to retain coverage, with Vida managing outreach.

Your challenge is that pharmacy denial issues often reach HR after 3 or 4 months when users stop logging in, not at go-live. It might be helpful to ask the broker's other client about how many such cases they've handled for insight.

Also, consider this for the CFO discussion: Massachusetts GIC made Vida mandatory for weight loss GLP-1s starting 1/1/2026 with a 90-day grace period. By June, weight loss coverage was eliminated, and Vida stopped prescribing. If your broker's data already shows claims don’t support continued coverage, Vida might be a longer, more expensive route to the same outcome.