Prescriptions

COPS Trust offers many different Medical and Rx plans designed specifically to fit the needs of the public safety sector. Our plans are supported by Blue Cross Blue Shield of Michigan and any other state Blue Cross Blue Shield Association member.

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New Program: Specialty Pharmacy Benefits

As part of our ongoing efforts to demonstrate excellent member experience while driving lower costs, Blue Cross Blue Shield of Michigan will be adding exclusive specialty pharmacy benefits to all self-funded groups effective January 1, 2026.

How it works:

  • Members who fill their prescriptions at a limited distribution drug pharmacy can continue using this pharmacy.
  • Members who get their specialty medications from pharmacies not listed will need to get new prescriptions from their health plan providers and use Walgreens Specialty Pharmacy to fill them. Walgreens Specialty Pharmacy is prepared to help members through this process.
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Rx Formulary Changes – Effective January 1, 2026

Beginning January 1, 2026, updates to the Blue Cross Custom Drug List will go into effect. Some medications will no longer be covered, including certain brand-name drugs and their generic equivalents. If you fill a prescription for one of these medications on or after that date, you may be responsible for the full cost.
To help with the transition, suggested covered alternatives—selected for their similar effectiveness, quality, and safety—are included. These may require prior authorization or meet other coverage requirements.
Click below to view the full list of changes and recommended alternatives.

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Understanding GLP-1 and Orphan Drugs: Why They May No Longer Be Covered

In recent years, certain types of medications – like GLP-1 drugs, orphan drugs, and ultra-orphan drugs – have received a lot of attention. You may have even seen them advertised on TV or heard about them from your doctor. These medications can offer real health benefits for specific conditions. However, many health plans have made the difficult decision to limit or stop coverage of some of these drugs. Here’s why.

What Are GLP-1 Drugs?

GLP-1 drugs (short for glucagon-like peptide-1 receptor agonists) were originally created to help people with type 2 diabetes control their blood sugar. Some examples include Ozempic®, Wegovy®, and Mounjaro®.

Over time, doctors also began prescribing these drugs for weight loss, especially for people who are overweight or obese. While they can be effective, they are also very expensive – often over $1,000 per month – and many people take them for long periods of time.

Americans spent an estimated $71.7 billion on GLP-1 drugs in 2023, a 500 percent increase from their spending on such drugs five years earlier.

Skyrocketing drug prices continue to drive up health insurance premiums – largely due to drugmakers setting unregulated prices and holding monopolies on many of the most expensive medications.

What Are Orphan and Ultra-Orphan Drugs?

These terms refer to rare disease medications:

  • Orphan drugs are used to treat conditions that affect fewer than 200,000 people in the U.S.
  • Ultra-orphan drugs treat even rarer diseases, often affecting fewer than 10,000 people.

Because these conditions are so uncommon, the medications often come with very high price tags – sometimes hundreds of thousands of dollars per patient per year. While these treatments can be life-changing for those who need them, the overall cost to the health plan can be difficult to manage, especially when more of these drugs are introduced every year.

What Are Orphan and Ultra-Orphan Drugs?

These terms refer to rare disease medications:

  • Orphan drugs are used to treat conditions that affect fewer than 200,000 people in the U.S.
  • Ultra-orphan drugs treat even rarer diseases, often affecting fewer than 10,000 people.

Because these conditions are so uncommon, the medications often come with very high price tags – sometimes hundreds of thousands of dollars per patient per year. While these treatments can be life-changing for those who need them, the overall cost to the health plan can be difficult to manage, especially when more of these drugs are introduced every year.

Why Coverage Is Changing

Health plans are designed to give the best value to as many employees as possible. That means making tough decisions to keep coverage affordable and sustainable for everyone.

Here are the main reasons groups are making changes:

  • High costs: These drugs can be extremely expensive – far more than standard medications.
  • Off-label use: Many GLP-1 drugs are being prescribed for weight loss even when not approved for that purpose under insurance plans.
  • Limited effectiveness for some users: Some people stop seeing benefits or discontinue use after a few months, but the plan still pays the full cost.
  • Rapid growth in use: The demand for GLP-1 and orphan drugs has skyrocketed, creating financial strain for employer-sponsored health plans.
What This Means for You

If you were using one of these medications, you may be affected by the coverage change. It’s important to:

  • Talk with your doctor about alternative treatments that are still covered.
  • Contact your health plan for a full list of what’s included and excluded.
  • Look into savings programs offered by drug companies or patient assistance programs, if available.
Our Commitment

Blue Water Benefits Administrators knows that these changes are not easy. Our goal is to keep your health plan strong and affordable for the long term.

If you have questions or want to better understand your benefits, please reach out to your HR or benefits team.