First Circuit upholds a health plan's weight-loss drug exclusion against a Section 1557 discrimination claim

The U.S. Court of Appeals for the First Circuit on Feb. 19, 2026, affirmed the dismissal of a proposed class action claiming that a health plan's exclusion of weight-loss drugs is illegal disability discrimination ^[1][3]. The decision in Whittemore v. Cigna Health & Life Insurance Co. leaves the exclusion in place and adds to a run of court losses for patients trying to use federal anti-discrimination law to force coverage of GLP-1 medications for obesity ^[1].

What the case argued

The plaintiff, an employee at the University of Maine enrolled in a Cigna-administered plan, sued in June 2024 under Section 1557 of the Affordable Care Act ^[1]. Her complaint said the plan's exclusion of GLP-1 drugs prescribed for obesity — including Wegovy (semaglutide) and Zepbound (tirzepatide) — amounted to discrimination against people with obesity, because the same drugs were covered under Cigna plans for other conditions such as diabetes ^[1]. The complaint also pointed to Cigna's own internal policies recognizing the drugs as medically necessary for treating obesity ^[1].

Section 1557 borrows its disability definition from Section 504 of the Rehabilitation Act, which in turn borrows from the Americans with Disabilities Act ^[2][3]. Under the ADA, a disability is a physical or mental impairment that "substantially limits one or more major life activities" ^[3].

What the court actually decided

The district court in Maine dismissed the case on Feb. 12, 2025, saying the allegations did not plausibly show the plaintiff was disabled "merely as a function of her body mass index (BMI)," or that Cigna had ever regarded her as disabled ^[2]. She appealed on March 19, 2025 ^[2].

The First Circuit affirmed, but on different reasoning ^[1][3]. It did not decide whether obesity can qualify as a disability. Instead, it found that her claim that obesity substantially limited major life activities such as walking, standing and sleeping amounted to conclusory "threadbare recitals of the elements of a cause of action" ^[3]. The court also rejected the broader argument that anyone diagnosed with obesity and prescribed medication for it is, by definition, substantially limited, saying general statements about obesity's potential health effects do not show that every person in that group is disabled under the ADA ^[3].

A companion case, Holland v. Elevance, was dismissed by the same district court on April 9, 2025, and appealed on April 21, 2025 ^[2]. Becker's reports that the district court there found the plaintiff's obesity could qualify as a disability but still dismissed because the weight-loss drug exclusion applied equally regardless of disability status ^[1]. A summary from Groom Law Group emphasizes a different point from that opinion — that the complaint's "regarded as disabled" allegations were conclusory ^[2]. That appeal has not yet been decided ^[1].

Why it matters for patients

For people whose plans exclude GLP-1s for weight management, this ruling narrows one legal path to challenging that exclusion. The court signaled that a diagnosis plus a prescription is not enough; disability is an individualized inquiry that requires facts about how the condition limits a specific person ^[2][3]. Because the First Circuit sidestepped the bigger question of whether obesity is ever a disability, the door is not fully closed — but the pleading bar is higher.

The legal fight is happening as coverage shrinks. One industry roundup cites GLP-1 list prices of roughly $617 to $766 a month, notes that weight-loss GLP-1s made up more than 10% of annual prescription drug claims in U.S. employer plans in 2025, and says 66% of employers with 5,000 or more workers called the spending impact "significant" ^[4]. That same summary lists Blue Cross Blue Shield of Massachusetts (for employers under 100 workers), Harvard Pilgrim Health Care, Blue Cross Blue Shield of Michigan and HCA Healthcare among those dropping weight-loss coverage in 2026, and notes federal law does not require employers to offer it ^[4].

What happens next

The Holland v. Elevance appeal remains pending at the First Circuit with no decision as of the Feb. 23, 2026, report ^[1]. Whether other circuits reach the same conclusion is not yet known.