Federal employee health plans must cover a GLP-1 for weight loss, though not necessarily Wegovy. OPM runs the Federal Employees Health Benefits (FEHB) Program. In 2023 it told every carrier to cover at least one anti-obesity drug from the GLP-1 class for weight loss, and at least 2 additional oral anti-obesity drugs[1]. OPM repeated that minimum in its call letter for 2027 plans[2].
Wegovy is a semaglutide brand and Zepbound a tirzepatide brand, and both are approved for weight management. OPM names neither. A plan meets the rule with any one GLP-1 on its formulary, so the brand your plan covers, and the prior authorization it asks for, are in that plan’s own drug list. What those brands cost when a plan does not cover them is in GLP-1 cost without insurance.
| Rule | Since | Source |
|---|---|---|
| No exclusion of weight-loss drugs as a lifestyle or cosmetic treatment | 2014 | OPM letter of 2014, as summarized in OPM's January 2023 letter |
| No exclusion of anti-obesity drugs by benefit exclusion or carve-out | 2022 | OPM letter of 2022, as summarized in OPM's January 2023 letter |
| At least one GLP-1 for weight loss, plus at least 2 oral options | 2023 | OPM carrier letter, January 2023; restated March 2026 |
| Intensive behavioral therapy before and during anti-obesity drug coverage | Plan Year 2027 | OPM call letter for 2027 plans, March 2026 |
Why FEHB plans cannot simply exclude weight-loss drugs
OPM’s 2023 letter recalls that in 2014 it clarified it is not permissible to exclude weight loss drugs on the basis that obesity is a “lifestyle” condition or that its treatment is “cosmetic”[1]. It adds that a 2022 letter said carriers are not allowed to exclude anti-obesity medications through a benefit exclusion or a carve-out[1].
The 2023 letter also says carriers must have adequate coverage of FDA-approved anti-obesity drugs on the formulary and must make their exception process available to members[1]. It extends that to drugs approved for adolescents aged 12 and older[1]. Where a plan applies prior authorization, the criteria must be transparent, readily accessible, and follow OPM’s turnaround timelines for standard and expedited reviews[1].
What changes for 2027: the behavioral therapy requirement
OPM’s call letter for Plan Year 2027, issued March 31, 2026, covers both the FEHB and the Postal Service Health Benefits programs[2]. It says the obesity management benefit must include set requirements before and while a plan covers an anti-obesity medication[2]. Prior authorization for any such drug must ensure the member has shown, and will continue, participation in lifestyle interventions meeting the rigor of intensive behavioral therapy (IBT)[2].
The letter is explicit that the drug and the program go together: an anti-obesity medication must only be covered when used concurrently with IBT[2]. It also closes a shortcut. Attestation statements alone, from members or providers, of prior weight-loss attempts should not bypass these requirements[2].
What plans must pay for on the program side
The letter lists minimum billing codes carriers must cover, including G0447 for individual IBT and G0473 for group IBT, with minimum coverage of up to 12 to 22 sessions per year depending on progress[2]. Members who also qualify for medical nutrition therapy must have it coordinated with their IBT benefit[2].
It also asks carriers to account for obesity-related physical impairment that substantially limits one or more major life activities when setting eligibility for anti-obesity drugs[2]. Carriers are strongly encouraged to cover these programs for adults with cardiometabolic risk factors and a BMI of at least 27, whether or not they take a drug[2].
What to check during Open Season
The 2027 rules apply to the contract term beginning January 1, 2027[2]. OPM’s Open Season page points to November 2026 for the next enrollment window[3]. When you compare plans, read three things in each brochure and formulary. Check which GLP-1 it lists for weight management and what its prior authorization asks for. Then check how it delivers the behavioral program it must now pair with the drug.
If a plan denies a covered-class drug, the exception and appeal routes are the plan’s; how federal appeal deadlines work for other plans is in Zepbound denied by insurance. Other federal programs set their own rules: see does TRICARE cover Wegovy for service members and does the VA cover Ozempic for veterans. Whether the maker’s savings card works with a federal employee plan is in Wegovy savings card.