Priority Health offers diabetes and weight programs through Virta, Livongo and Omada, and eligibility turns on both the member and the employer.
Priority Health lists Virta, Livongo, Omada and the National Diabetes Prevention Program for commercial group members. Each has its own eligibility rules.
What the program is and what members do.
Virta for type 2 diabetes
Priority Health describes Virta as a digital program with customized care plans, dedicated coaching and on-demand access to clinician-led care teams. Its Diabetes Reversal program uses nutrition therapy to help members reduce blood sugar and diabetes medication. Priority Health defines reversal as an A1c below 6.5% without medications beyond metformin, and notes results can return if lifestyle changes are not maintained.
Virta weight loss programs
Priority Health lists two Virta weight programs. Sustainable Weight Loss uses nutrition therapy without medications. Sustainable Weight Loss with Responsible Prescribing adds optimized GLP-1 use through Virta’s Trusted Prescriber Network, with a path to a clinically monitored offramp. Members have only one of the two, depending on what the employer selected.
Livongo, Omada and prevention
Livongo is a digital diabetes program with coaching, a glucose meter with unlimited test strips, a connected scale and a blood pressure cuff. Omada and the National Diabetes Prevention Program support lifestyle change for members at risk. Priority Health says all commercial members diagnosed with pre-diabetes are eligible for Omada.
Eligibility, funding and plan design.
Member eligibility
Priority Health lists adults 18 or older. Virta diabetes requires a type 2 diagnosis with an A1c of 6.5% or higher. Sustainable Weight Loss requires a BMI of 25 or more, or an A1c of 5.7% to 6.4%. The prescribing version requires meeting FDA criteria for GLP-1s, including a BMI of 30 or more, or 27 or more with comorbidities.
Employer purchase
Priority Health says Livongo is open to members whose employer has the Livongo buy-up, and notes that most groups have Virta instead. Virta applies to any commercial group member who meets the criteria, other than those with the Livongo buy-up. The prescribing weight program is something the group has to have.
Plan design fit
These programs address costly chronic conditions, so they matter most to groups with meaningful diabetes or obesity claims. A GLP-1 pathway also touches pharmacy cost, which is a separate budget line. Plan design should state how program participation interacts with drug coverage.
What to settle before relying on it.
Which weight program does our group have, if any?
Priority Health says members have one Virta weight plan or none. Ask which version your group purchased and whether the GLP-1 pathway changes pharmacy spend. Employees will ask about GLP-1 access, so the answer needs to be consistent in every communication.
What does the diabetes program replace, and what does it add?
If your group has Virta, ask how it coordinates with existing care management and pharmacy benefits. Ask what Priority Health reports on enrollment and clinical outcomes, and whether those figures reflect your group or the book as a whole. Ask also how members are told about the program, since low awareness is the usual reason enrollment disappoints.
Are any rewards attached to participation?
Programs that reward enrollment or outcomes can fall under HIPAA and ACA wellness rules, and health data collection can raise ADA and GINA issues. Have employment counsel review any incentive linked to these programs. A clinical program offered without a reward is a simpler design.
Common questions about this program.
Do all Priority Health members get Virta?
No. Priority Health lists commercial group members who meet the clinical criteria, and the employer’s selections determine which Virta program applies. Eligibility varies by plan and funding.
What does Priority Health mean by diabetes reversal?
Priority Health defines it as reaching an A1c below 6.5% without diabetes medications beyond metformin. It also states that diabetes and related issues can return if lifestyle changes are not maintained.
Is Livongo still offered?
Priority Health’s manual lists Livongo, owned by Teladoc Health, for members whose employer group has the Livongo buy-up. It notes most groups have Virta, so confirm which one your group has.
Programs and vendors named on this page
Official pages for the services mentioned above. Availability, cost and eligibility vary by plan and employer group, so confirm what applies to your group with the carrier.
Livongo by Teladoc Health
Connected diabetes and chronic condition program.
Where these details come from.
This page summarizes what Priority Health publishes. Programs change, so confirm current details with the carrier before relying on them.
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