SUMMARY OF MATERIAL MODIFICATIONS October 2025
Sunday, October 19, 2025
SUMMARY OF MATERIAL MODIFICATIONS
FOR ACTIVE PARTICIPANTS, PRE-MEDICARE RETIREES, AND PRE-MEDICARE ELIGIBLE DEPENDENTS
October 2025
Dear Participant:
This notice, referred to as a Summary of Material Modifications (SMM), describes important changes to the benefits offered by the National Automatic Sprinkler Industry (NASI) Welfare Fund (Fund) to active participants, pre-Medicare retirees, and pre-Medicare eligible dependents effective January 1, 2026. We encourage you to read this notice carefully and to keep it with your Summary Plan Description and Plan Document (Plan). If you have any questions, please contact the Fund Office.
Effective January 1, 2026, the Plan Will Not Cover GLP-1 Medications Prescribed for Weight Loss or Sleep Apnea
The Board of Trustees routinely reviews the prescription drug coverage offered by the Plan, and its associated cost. Recently, the Fund has experienced an enormous increase in expenses arising from glucagon-like peptide-1 (GLP-1) medications. These medications are used to treat a variety of indications but are sometimes prescribed for weight loss (including weight loss intended to alleviate obstructive sleep apnea). Presently, the Plan generally covers GLP-1s prescribed for weight loss and sleep apnea with minimal limitation.
Effective for prescriptions filled on and after January 1, 2026, in an effort to contain expenses and maintain the financial integrity of the Fund, the Plan will not cover GLP-1 medications prescribed for weight loss or obstructive sleep apnea. The Plan will continue to cover Medically Necessary GLP-1s for treatment of: (1) diabetes when you have a documented diagnosis of Type 2 diabetes, or (2) cardiovascular disease when you have a documented risk of cardiovascular disease and a documented cardiovascular incident, subject to prior authorization from OptumRx and all applicable Plan provisions.
This decision was not made lightly. Although many users of GLP-1s have utilized these medications for weight loss and obstructive sleep apnea with great success, the Board must balance the potential benefits of covering certain medications, like GLP-1s, with the impact their cost has on the Fund’s overall financial posture.
If, in consultation with your doctor, you decide to continue taking GLP-1s prescribed for weight loss or obstructive sleep apnea, please refer to the second page of this notice for a partial listing of independent resources for obtaining GLP-1s without Plan coverage, often at a discounted cost, at your expense. Please be mindful that this listing is current as of October 2025 and is subject to change at any time, without notice to you or the Fund Office.
Conclusion
The Board will continue to monitor and manage the Fund’s resources in an effort to ensure that it is able to provide high quality health coverage to members and their families. As always, if you have any questions about this correspondence, or the Fund in general, please feel free to contact the Fund Office.
This summary of material modifications is intended as a non-technical summary of certain changes to the rules of the NASI Welfare Fund, so it does not contain all the details. It modifies the information set forth in the Fund’s Summary Plan Description and Plan Document that was previously provided to you. In the event of a discrepancy between this summary of material modifications and the official Plan document, the official Plan document, as interpreted and applied solely by the Trustees pursuant to their exclusive discretionary authority, will prevail. The Trustees reserve the right to modify the official Plan document and the benefits offered by the NASI Welfare Fund at any time.
NON-EXHAUSTIVE LISTING OF INDEPENDENT RESOURCES FOR OBTAINING GLP-1 MEDICATIONS AT YOUR OWN EXPENSE AND WITHOUT PLAN COVERAGE
Effective for prescriptions filled on and after January 1, 2026, the NASI Welfare Fund will not cover GLP-1 medications prescribed for weight loss or obstructive sleep apnea for active participants, pre-Medicare retirees, and pre-Medicare eligible dependents. If, in consultation with your doctor, you decide to continue taking GLP-1 medications prescribed for weight loss or obstructive sleep apnea at your own expense, below is a non-exhaustive listing of resources for obtaining GLP-1s without Plan coverage, often at a discounted cost. Of course, the Fund does not endorse or encourage you to use any of the following options. In addition, you should be mindful that this listing is current as of October 2025 and is subject to change at any time without notice to you or the Fund Office. Please speak with your doctor before taking these medications and discuss what options are best for you.
- Prescription Discount Cards and Offerings. Prescription discount cards are designed to provide lower drug costs to patients paying for their medications out-of-pocket. They are available even if you have insurance. You simply download a mobile application (or access online), search for your medication, show the coupon or discount at the pharmacy, and pay the discounted rate – just like any other coupon. Commonly known vendors for prescription discount cards are GoodRx and SingleCare. Both vendors offer discounts on GLP-1 medications at participating pharmacies. Also, the Costco Member Prescription Program offers a direct-to-members savings program that enables Costco-membership holders to obtain Wegovy and Ozempic with a prescription and without insurance coverage.
- Manufacturer Savings Programs. Manufacturer Savings Programs are typically for expensive, brand-name medications, so they are a useful resource for minimizing costs for GLP-1 medications. In the event your insurance doesn’t cover a medication, the manufacturer may cover all or some of your costs. Generally, you can obtain a manufacturer copay card through the manufacturer’s website. For many of these programs, there is an expiration date and/or maximum savings limit, but it varies per medication. Some states have enacted legislation to limit the use of these programs, so you should ask your provider or pharmacist about the availability of manufacturer copay cards for your medication. Manufacturers like Novo Nordisk (produces Wegovy, Ozempic, Rybelsus) and Eli Lilly (produces Mounjaro, Zepbound) offer savings cards for their medications. You can research the manufacturer’s website online, but a few examples are:
- Patient Assistance Programs. Some pharmaceutical manufacturers, non-profits, and foundations have developed programs to provide financial assistance for patients to afford medications when their insurance does not cover a specific drug. Each program has unique enrollment and qualification requirements. In many cases, there is an income threshold to qualify for such programs. Search online for patient assistance programs that cover the specific medication you need or ask your doctor for recommendations. The following are examples of organizations that provide patient assistance programs:
- Telehealth Services. Online telehealth services provide a convenient way to access GLP-1 medications without insurance. After creating a profile, you will meet with a licensed provider via video or online intake to determine if you qualify. They offer a cash-pay model, where you pay a fixed monthly fee for the prescription, medication, and ongoing support. The following is a popular telehealth service: Calibrate (www.joincalibrate.com).
- OptumRx Drug Discount Program. The Fund’s Pharmacy Benefit Manager, OptumRx, established the Price Edge Program to deliver automatic discounts for some medications not covered by the Plan. When a non-covered medication is rejected at the pharmacy, the claim will be routed through OptumRx’s Price Edge Program to determine if a copay coupon is available to reduce the out-of-pocket cost of the medication. Simply present your OptumRx Member ID card at the pharmacy, and discounts (if available) are automatically applied on non-covered drugs under the Price Edge Program.
