# Medical and Prescription Changes for 2026 ## What's Changing for 2026? For 2026, the University Benefits Committee (UBC) has recommended—and the University has approved—changes to the Non-Union plans. These changes address rising health care costs and ensure the continued strength of our plans. - We’ve highlighted the changes below. Visit Harvie to learn more about the University’s changes, including access to updated 2026 premium information. - You can learn more about the UBC’s guiding principles and the health care trends influencing our plans in this [**Harvard Gazette interview**](https://news.harvard.edu/gazette/story/2025/09/harvards-healthcare-plans-whats-changing-whats-staying-the-same/). **Important:** These changes apply to all Non-Union members, regardless of your medical carrier (HUGHP or BCBSMA). Non-Union Changes (HMO, POS, & POS Plus) Union Plan Changes (HMO & POS) ## Non-Union Changes (HMO, POS, & POS Plus) Copayments, deductibles, and out-of-pocket maximums are increasing as follows: Open all sections Close all sections ### In Network HMO & POS expand\_more Sort 2025 2026 **Deductible:** Individual Family (other coverage levels) $250 $750 $500 $1,500 **Out-of-Pocket Maximum:** Individual Family (other coverage levels) $1,500 $4,500 $1,600 $4,800 **Emergency Room** $100 $150 **Office Visits:** PCP, specialist, occupational and physical therapy, chiropractic, acupuncture, and urgent care $30 $40 **Telehealth via Well Connection (and non–Well Connection for Behavioral Health)** $15 $20 **Mental Health/Substance Abuse:** In-Patient Care Outpatient Office Visits Telehealth via Well Connection (and non–Well Connection for Behavioral Health) 10% coinsurance after deductible $30 $15 10% coinsurance after deductible $40 $20 ### In Network POS Plus expand\_more Sort 2025 2026 **Emergency Room** $100 $150 **Office Visits:** PCP, specialist, occupational and physical therapy, chiropractic, acupuncture, and urgent care $30 $40 **Mental Health/Substance Abuse:** In-Patient Care Outpatient Office Visits Telehealth via Well Connection (and non–Well Connection for Behavioral Health) $0 $30 $15 $0 $40 $20 ### Out of Network POS expand\_more Sort 2025 2026 **Deductible:** Individual Family (other coverage levels) $750 $2,500 $1,800 $6,000 **Out-of-Pocket Maximum:** Individual Family (other coverage levels) $2,500 $7,500 $2,600 $7,800 **Emergency Room** $100 $150 **Urgent Care** (at an Urgent Care Center) *Urgent care outside of Massachusetts may require an out-of-the-area/out-of-state urgent care referral.* [*Please contact HUGHP Member Services*](/contact-us "Contact Us")*.* $30 $40 **Acupuncture** (up to 20 visits per year) $30 $40 ### Out of Network POS Plus expand\_more Sort 2025 2026 **Emergency Room** $100 $150 **Urgent Care** (at an Urgent Care Center) *Urgent care outside of Massachusetts may require an out-of-the-area/out-of-state urgent care referral.* [*Please contact HUGHP Member Services*](/contact-us "Contact Us")*.* $30 $40 **Acupuncture** (up to 20 visits per year) $30 $40 ### Prescription Drug Copayment Changes for All Non-Union Plans expand\_more ### Prescription Copayments Sort 2025 2026 **Retail:** **Tier 1:** Most generic drugs **Tier 2:** Preferred brand-name drugs **Tier 3:** Non-preferred brand-name drugs $7 $20 $45 $10 $25 $55 **Mail:** **Tier 1:** Most generic drugs **Tier 2:** Preferred brand-name drugs **Tier 3:** Non-preferred brand-name drugs $14 $50 $110 $20 $60 $130 **Preventive Retail:** **Tier 1:** Most generic drugs **Tier 2:** Preferred brand-name drugs **Tier 3:** Non-preferred brand-name drugs $0 $10 N/A $0 $12.50 N/A **Preventive Mail:** **Tier 1:** Most generic drugs **Tier 2:** Preferred brand-name drugs **Tier 3:** Non-preferred brand-name drugs $0 $25 N/A $0 $30 N/A ### Prescription Drug Coverage Changes for All Non-Union Plans expand\_more ### Prescription Drug Coverage Every year, prescription drugs are reviewed to ensure coverage criteria remain current. In 2026, the guidelines for some medications will change, including GLP-1 drugs used for weight loss. These medications will still be covered for weight loss, but the criteria are being updated to better match coverage standards. If you are impacted, you will be notified by mail. Beginning January 1, 2026, the coverage requirements will change for GLP-1 medications used for weight loss. The University is introducing a comprehensive weight management program called EncircleRx to support members using these medications for weight management. EncircleRx incorporates updated clinical criteria for coverage, along with an ongoing lifestyle modification program through 9amHealth. There will be no change to the coverage guidelines for GLP-1 medications used to treat diabetes. The following [**GLP-1 Clinical Change & Coverage Requirement FAQs**](https://harvie.harvard.edu/sites/g/files/omnuum12046/files/2025-10/GLP1_Clinical_Changes_FAQ.pdf) provide more details about these updates and what they mean for members. #### Look up Your Prescription Copayment Estimate Visit [**Express Scripts Pharmacy Benefit Estimate Tool (express-scripts.com)**](https://www.express-scripts.com/frontend/commercial-open-enrollment/HarvardUniversity) and follow the instructions below. *(The search tool is based on the 2026 calendar year benefits.)* - Select the HUGHP plan that applies to you (HUGHP HMO POS Nonunion, HUGHP HMO POS Union, or HUGHP POS Plus Nonunion) and click “View Details.” - Select the “Price a Medication” box - Type in the name of the medication and provide all information that is listed in the boxes below the medication box tool **Note:** Information provided on the Express Scripts website is an estimate only. ### No-Cost Benefits Expanded for Certain Care expand\_more **Nutritional Counseling** Nutritional counseling can play an important role in weight management, the prevention of chronic conditions, and the development of sustainable, healthy habits. Effective January 1, all members will have access to 3 nutritional visits at no cost. Members must use a network provider to take advantage of this benefit. **Expanded No-Cost Breast Cancer Screening** The Commonwealth of Massachusetts passed a law regarding breast cancer screening coverage. In response, effective January 1, we’re removing cost share for eligible breast MRIs. Screening mammograms and breast ultrasounds are already covered without cost-share. Members must continue to use a network provider for this care. **Recovery Coaching Offered at No Cost to Members** Effective January 1, members will have access to support for substance abuse disorders by seeing a licensed recovery coach at no cost. Recovery coaches must be licensed through the Massachusetts Department of Public Health. At this time, the Massachusetts Department of Public Health (DPH) has not issued final regulations establishing the licensure requirements for Recovery Coaches. Because licensure is required by the state, no providers currently meet the criteria to provide these services. During the interim period, members can access peer recovery support in Massachusetts through Dynamicare. [DynamiCare](https://get.dynamicarehealth.com/bcbsma/) is a network provider that offers comprehensive virtual coaching and therapeutics to help individuals 13 and older to quit or moderate their use of alcohol, drugs, and tobacco, delivered through a smartphone app. We will update our website with additional information as we learn more about the licensure requirements. **Substance Use Disorder** Effective January 1, opioid antagonists used to treat overdoses, such as Narcan, will be covered under the medical benefit without prior authorization. This means that, if indicated, medical facilities can provide members with a Narcan kit upon discharge at no cost. Members may still access Narcan through a pharmacy at no cost and without prior authorization. ## Union Plan Changes (HMO & POS) HUCTW, ATC, HUSPMGU, HUPA, Local 26, SEIU Custodians, and SEIU Arboretum plans. Open all sections Close all sections ### Prescription Drug Coverage Changes for All Union Plans expand\_more ### Prescription Drug Coverage Every year, prescription drugs are reviewed to ensure coverage criteria remain current. In 2026, the guidelines for some medications will change, including GLP-1 drugs used for weight loss. These medications will still be covered for weight loss, but the criteria are being updated to better match coverage standards. If you are impacted, you will be notified by mail. For more details, see [**https://harvie.harvard.edu/open-enrollment-2026**.](https://harvie.harvard.edu/open-enrollment-2026.) Beginning January 1, 2026, the coverage requirements will change for GLP-1 medications used for weight loss. The University is introducing a comprehensive weight management program called EncircleRx to support members using these medications for weight management. EncircleRx incorporates updated clinical criteria for coverage, along with an ongoing lifestyle modification program through 9amHealth. There will be no change to the coverage guidelines for GLP-1 medications used to treat diabetes. The following [**GLP-1 Clinical Change & Coverage Requirement FAQs**](https://harvie.harvard.edu/sites/g/files/omnuum12046/files/2025-10/GLP1_Clinical_Changes_FAQ.pdf) provide more details about these updates and what they mean for members. #### Look up Your Prescription Copayment Estimate Visit [**Express Scripts Pharmacy Benefit Estimate Tool (express-scripts.com)**](https://www.express-scripts.com/frontend/commercial-open-enrollment/HarvardUniversity) and follow the instructions below. *(The search tool is for the 2026 calendar year benefits.)* - Select the HUGHP plan that applies to you (HUGHP HMO POS Nonunion, HUGHP HMO POS Union, or HUGHP POS Plus Nonunion) and click “View Details.” - Select the “Price a Medication” box - Type in the name of the medication and provide all information that is listed in the boxes below the medication box tool **Note:** Information provided on the Express Scripts website is an estimate only. ### No-Cost Benefits Expanded for Certain Care expand\_more **Nutritional Counseling** Nutritional counseling can play an important role in weight management, the prevention of chronic conditions, and the development of sustainable, healthy habits. Effective January 1, all members will have access to 3 nutritional visits at no cost. Members must use a network provider to take advantage of this benefit. **Expanded No-Cost Breast Cancer Screening** The Commonwealth of Massachusetts passed a law regarding breast cancer screening coverage. In response, effective January 1, we’re removing cost share for eligible breast MRIs. Screening mammograms and breast ultrasounds are already covered without cost-share. Members must continue to use a network provider for this care. **Recovery Coaching Offered at No Cost to Members** Effective January 1, members will have access to support for substance abuse disorders by seeing a licensed recovery coach at no cost. Recovery coaches must be licensed through the Massachusetts Department of Public Health. At this time, the Massachusetts Department of Public Health (DPH) has not issued final regulations establishing the licensure requirements for Recovery Coaches. Because licensure is required by the state, no providers currently meet the criteria to provide these services. During the interim period, members can access peer recovery support in Massachusetts through Dynamicare. [DynamiCare](https://get.dynamicarehealth.com/bcbsma/) is a network provider that offers comprehensive virtual coaching and therapeutics to help individuals 13 and older to quit or moderate their use of alcohol, drugs, and tobacco, delivered through a smartphone app. We will update our website with additional information as we learn more about the licensure requirements. **Substance Use Disorder** Effective January 1, opioid antagonists used to treat overdoses, such as Narcan, will be covered under the medical benefit without prior authorization. This means that, if indicated, medical facilities can provide members with a Narcan kit upon discharge at no cost. Members may still access Narcan through a pharmacy at no cost and without prior authorization.