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Starting with the 2026 QP performance period, the Threshold Score for an APM Entity or eligible clinician is calculated as a percent by dividing the value described under paragraph (e)(1) of this section by the value described under paragraph (e)(2) of this section

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doi: 10.3389/fphar.2025.1675552

The response from many of those employers has been swift: Blue Cross Blue Shield of Massachusetts dropped GLP-1 coverage for obesity treatment for employers with fewer than 100 employees at the start of 2026 Harvard Pilgrim Health Care and Blue Cross Blue Shield of Michigan both dropped weight-loss GLP-1 coverage in 2026 HCA Healthcare one of the countrys largest hospital systems notified employees that its GLP-1 coverage was ending after usage surged 90% in a single year, directing workers instead toward manufacturer cash-pay programs Several other employers have stopped short of elimination but have tightened requirements dramatically restricting coverage only to patients with a formal diabetes diagnosis and removing access for patients using GLP-1s for weight management alone. Why Are Employers Cutting This Coverage Now