Originally published Whither GLP-1s for weight loss in the FEHB? on by https://federalnewsnetwork.com/commentary/2025/05/whither-glp-1s-for-weight-loss-in-the-fehb/ at Federal News Network
While the use of Glucagon-like peptide-1 (GLP-1) receptor agonists for treating Type 2 diabetes is well established, strong evidence also supports use of these medications for weight loss. Employer-based health insurance coverage for these prescription drugs currently lags behind this evidence: only one fourth of large employers offer coverage of GLP-1s for weight loss to their employees. Federal health policy also has been slow to respond: The outgoing Biden administration proposed coverage of GLP-1s for weight loss by Medicare and Medicaid in November of 2024.
Although the Trump administration has not taken up the issue directly, their recent addendum to the Office of Personnel Management’s Call Letter for the 2026 plan year dismissed requirements for Federal Employees Health Benefits (FEHB) program plans to follow evidence-based guidelines for GLP-1 use for obesity management. Given that the FEHB program has received widespread accolades for its approach to obesity management — having covered GLP-1s for weight loss for two years — this “oh, never mind” from the new administration is curious, confusing and potentially very expensive.
FEHB policy on weight loss
The FEHB program is a marketplace of health insurance carriers from which federal employees and retirees select their health coverage on an annual basis. The FEHB covers 8.2 million enrollees throughout the country and overseas. FEHB market penetration ranges from 2% to 10% depending on the service area and incorporates most major insurance carriers and prominent statewide or regional HMOs. As such, policy developments within the FEHB can influence the wider commercial insurance marketplace. For example, in 1999, President Clinton directed the FEHB program to require participating health plans to implement mental health parity. Subsequent evaluation of that successful effort contributed to passage of the Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008, mandating mental health parity across all insurers.
For more than a decade, the Office of Personnel Management, which oversees the FEHB, has maintained a consistent focus on obesity management. Between 2011 and 2013, OPM issued three Carrier Letters (CL 2011-05, CL 2012-09, CL 2013-10) encouraging health plans to cover weight management interventions inclusive of nutritional counseling, exercise, health coaching and — if appropriate — bariatric surgery. In 2014, OPM issued Carrier Letter 2014-04 clarifying that it is not permissible for FEHB plans to exclude weight loss drugs from FEHB coverage on the basis that obesity is a “lifestyle” condition and not a medical one or that obesity treatment is “cosmetic.” In 2019, OPM reminded carriers of their obligation to cover intensive behavioral therapy (IBT) for obesity management if referred as the result of a preventive screening. IBT is defined as a multicomponent process that includes obesity-related specialists focused on nutrition, physical activity and behavior change components.
Carrier Letter 2023-01, entitled “Prevention and Treatment of Obesity,” provided a comprehensive set of recommendations for health plans: screening and prevention, anti-obesity medications, and bariatric/metabolic surgery. That directive required that carriers “cover at least one anti-obesity drug from the GLP-1 class for weight loss and cover at least two additional oral anti-obesity drug options.” Carriers also were directed to evaluate and update their coverage of anti-obesity drugs as new anti-obesity drugs are approved by the FDA.
By requiring coverage of GLP-1s for weight loss, OPM distinguished itself as a market leader. In an April 2024 report, the Milken Institute recognized OPM’s coverage policy as a leading example of the type of obesity management benefit employers should offer. In particular, the Milken report highlights the comprehensiveness of the OPM approach, covering specific preventive services for adults, children and adolescents and treatment services that include multi-component behavioral interventions, anti-obesity medications and bariatric/metabolic surgery.
Balancing coverage, care management and cost
According to the Kaiser Family Foundation’s 2024 Employer Health Benefits Survey, only 18% of firms with 200 or more employees cover GLP-1s for weight loss. The KFF survey reports that more than half of the firms that cover GLP-1s for weight loss require use of these medications be accompanied by services from complementary providers (such as a dietitian, psychologist, case worker or therapist). Two thirds of the larger firms covering GLP-1s for weight loss acknowledged that this coverage will have a “moderate” or “significant” impact on their prescription drug spending.
Between 2024 and 2025, premiums for FEHB plans increased by 11.2%, the largest increase in FEHB premiums in more than two decades. OPM attributes this rise in premiums to “increases in trend due to the impact of price increases by providers and suppliers, increased utilization, and costs of prescription drugs, particularly specialty medications and GLP-1s, and increased cost and utilization in outpatient services including surgery, physician and mental health.”
OPM has consistently emphasized the need for intensive behavioral therapy as a key component of weight loss management, including as a necessary complement to the use of weight loss medications. This policy reflects advice from professional bodies, such as the American College of Occupational and Environmental Medicine (ACOEM), which notes that “the present availability of coverage for obesity care is piecemeal” and calls for “guidance on how to operationalize evidence-based behavioral, nutritional, pharmacological, and surgical obesity treatment modalities as health benefits.” The ACOEM further notes that obesity represents an ongoing cost to employers and society at large in the form of current and future health care expenses, “absenteeism, presenteeism, and workers’ compensation costs related to injuries and illnesses.”
OPM’s 2025 Call Letter, issued January 15, 2025, identified this context of rising utilization and cost amidst inconsistent application of comprehensive, evidence-based care. And, in response, the Call Letter required FEHB plans to cover comprehensive obesity management measures, including screening and support services; child, adolescent and family programming; specialized obesity care teams of registered dietitians and obesity-trained physicians; evidence-based intensive behavioral therapy; medication review; and patient monitoring. By requiring these elements, OPM was attempting to more tightly manage the use of GLP-1s to rein in costs while striving for optimal value and effectiveness.
Evidence-based policy muted or reversed?
In an unprecedented move, the Trump administration issued an Addendum to the OPM Call Letter on January 31, 2025 stating that OPM “no longer require[s] Plan Year 2026 proposals to clarify or update the obesity management benefit to include the elements listed in the bullets starting on the bottom of page 10 and continuing through the bottom of page 12 of Carrier Letter 2025-01.” In other words, the evidence-based policy guidance to better manage the obesity benefit issued two weeks earlier no longer required carriers’ attention. There is no further elaboration on this point. Is the Trump administration stating that carriers should no longer follow the latest clinical evidence on obesity management? Or are they saying, “you may or may not follow this guidance; we don’t really care?”
If the carriers ignore the latest obesity management guidance, there is a better than even chance that GLP-1 utilization and costs will continue to grow exponentially while some of the value of the benefit will be squandered because intensive behavioral therapy will not accompany the use of the medication. Can federal employees and retirees sustain another 11.2% growth in premiums? What services will be crowded out to make room for GLP-1s?
Jonathan Foley is a senior executive with more than 35 years of experience in health policy development and health systems management. Currently a health care consultant, Jon served as senior advisor to the director of OPM during the Obama and Biden administrations.
Originally published Whither GLP-1s for weight loss in the FEHB? on by https://federalnewsnetwork.com/commentary/2025/05/whither-glp-1s-for-weight-loss-in-the-fehb/ at Federal News Network
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Whither GLP-1s for weight loss in the FEHB?
Originally published Whither GLP-1s for weight loss in the FEHB? on by https://federalnewsnetwork.com/commentary/2025/05/whither-glp-1s-for-weight-loss-in-the-fehb/ at Federal News Network
https://federalnewsnetwork.com/wp-content/uploads/2023/04/FEHB-Program-1024x689.jpgWhile the use of Glucagon-like peptide-1 (GLP-1) receptor agonists for treating Type 2 diabetes is well established, strong evidence also supports use of these medications for weight loss. Employer-based health insurance coverage for these prescription drugs currently lags behind this evidence: only one fourth of large employers offer coverage of GLP-1s for weight loss to their employees. Federal health policy also has been slow to respond: The outgoing Biden administration proposed coverage of GLP-1s for weight loss by Medicare and Medicaid in November of 2024.
Although the Trump administration has not taken up the issue directly, their recent addendum to the Office of Personnel Management’s Call Letter for the 2026 plan year dismissed requirements for Federal Employees Health Benefits (FEHB) program plans to follow evidence-based guidelines for GLP-1 use for obesity management. Given that the FEHB program has received widespread accolades for its approach to obesity management — having covered GLP-1s for weight loss for two years — this “oh, never mind” from the new administration is curious, confusing and potentially very expensive.
FEHB policy on weight loss
The FEHB program is a marketplace of health insurance carriers from which federal employees and retirees select their health coverage on an annual basis. The FEHB covers 8.2 million enrollees throughout the country and overseas. FEHB market penetration ranges from 2% to 10% depending on the service area and incorporates most major insurance carriers and prominent statewide or regional HMOs. As such, policy developments within the FEHB can influence the wider commercial insurance marketplace. For example, in 1999, President Clinton directed the FEHB program to require participating health plans to implement mental health parity. Subsequent evaluation of that successful effort contributed to passage of the Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008, mandating mental health parity across all insurers.
For more than a decade, the Office of Personnel Management, which oversees the FEHB, has maintained a consistent focus on obesity management. Between 2011 and 2013, OPM issued three Carrier Letters (CL 2011-05, CL 2012-09, CL 2013-10) encouraging health plans to cover weight management interventions inclusive of nutritional counseling, exercise, health coaching and — if appropriate — bariatric surgery. In 2014, OPM issued Carrier Letter 2014-04 clarifying that it is not permissible for FEHB plans to exclude weight loss drugs from FEHB coverage on the basis that obesity is a “lifestyle” condition and not a medical one or that obesity treatment is “cosmetic.” In 2019, OPM reminded carriers of their obligation to cover intensive behavioral therapy (IBT) for obesity management if referred as the result of a preventive screening. IBT is defined as a multicomponent process that includes obesity-related specialists focused on nutrition, physical activity and behavior change components.
Carrier Letter 2023-01, entitled “Prevention and Treatment of Obesity,” provided a comprehensive set of recommendations for health plans: screening and prevention, anti-obesity medications, and bariatric/metabolic surgery. That directive required that carriers “cover at least one anti-obesity drug from the GLP-1 class for weight loss and cover at least two additional oral anti-obesity drug options.” Carriers also were directed to evaluate and update their coverage of anti-obesity drugs as new anti-obesity drugs are approved by the FDA.
By requiring coverage of GLP-1s for weight loss, OPM distinguished itself as a market leader. In an April 2024 report, the Milken Institute recognized OPM’s coverage policy as a leading example of the type of obesity management benefit employers should offer. In particular, the Milken report highlights the comprehensiveness of the OPM approach, covering specific preventive services for adults, children and adolescents and treatment services that include multi-component behavioral interventions, anti-obesity medications and bariatric/metabolic surgery.
Balancing coverage, care management and cost
According to the Kaiser Family Foundation’s 2024 Employer Health Benefits Survey, only 18% of firms with 200 or more employees cover GLP-1s for weight loss. The KFF survey reports that more than half of the firms that cover GLP-1s for weight loss require use of these medications be accompanied by services from complementary providers (such as a dietitian, psychologist, case worker or therapist). Two thirds of the larger firms covering GLP-1s for weight loss acknowledged that this coverage will have a “moderate” or “significant” impact on their prescription drug spending.
Between 2024 and 2025, premiums for FEHB plans increased by 11.2%, the largest increase in FEHB premiums in more than two decades. OPM attributes this rise in premiums to “increases in trend due to the impact of price increases by providers and suppliers, increased utilization, and costs of prescription drugs, particularly specialty medications and GLP-1s, and increased cost and utilization in outpatient services including surgery, physician and mental health.”
OPM has consistently emphasized the need for intensive behavioral therapy as a key component of weight loss management, including as a necessary complement to the use of weight loss medications. This policy reflects advice from professional bodies, such as the American College of Occupational and Environmental Medicine (ACOEM), which notes that “the present availability of coverage for obesity care is piecemeal” and calls for “guidance on how to operationalize evidence-based behavioral, nutritional, pharmacological, and surgical obesity treatment modalities as health benefits.” The ACOEM further notes that obesity represents an ongoing cost to employers and society at large in the form of current and future health care expenses, “absenteeism, presenteeism, and workers’ compensation costs related to injuries and illnesses.”
OPM’s 2025 Call Letter, issued January 15, 2025, identified this context of rising utilization and cost amidst inconsistent application of comprehensive, evidence-based care. And, in response, the Call Letter required FEHB plans to cover comprehensive obesity management measures, including screening and support services; child, adolescent and family programming; specialized obesity care teams of registered dietitians and obesity-trained physicians; evidence-based intensive behavioral therapy; medication review; and patient monitoring. By requiring these elements, OPM was attempting to more tightly manage the use of GLP-1s to rein in costs while striving for optimal value and effectiveness.
Evidence-based policy muted or reversed?
In an unprecedented move, the Trump administration issued an Addendum to the OPM Call Letter on January 31, 2025 stating that OPM “no longer require[s] Plan Year 2026 proposals to clarify or update the obesity management benefit to include the elements listed in the bullets starting on the bottom of page 10 and continuing through the bottom of page 12 of Carrier Letter 2025-01.” In other words, the evidence-based policy guidance to better manage the obesity benefit issued two weeks earlier no longer required carriers’ attention. There is no further elaboration on this point. Is the Trump administration stating that carriers should no longer follow the latest clinical evidence on obesity management? Or are they saying, “you may or may not follow this guidance; we don’t really care?”
If the carriers ignore the latest obesity management guidance, there is a better than even chance that GLP-1 utilization and costs will continue to grow exponentially while some of the value of the benefit will be squandered because intensive behavioral therapy will not accompany the use of the medication. Can federal employees and retirees sustain another 11.2% growth in premiums? What services will be crowded out to make room for GLP-1s?
Jonathan Foley is a senior executive with more than 35 years of experience in health policy development and health systems management. Currently a health care consultant, Jon served as senior advisor to the director of OPM during the Obama and Biden administrations.
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Originally published Whither GLP-1s for weight loss in the FEHB? on by https://federalnewsnetwork.com/commentary/2025/05/whither-glp-1s-for-weight-loss-in-the-fehb/ at Federal News Network
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