First Circuit upholds Cigna plan's exclusion of weight-loss drugs

The U.S. Court of Appeals for the First Circuit ruled on Feb. 19, 2026 that a lawsuit challenging a Cigna-administered health plan's exclusion of weight-loss drugs should be dismissed, handing the insurer a win in a proposed class action ^[1][3].

The plaintiff worked at the University of Maine and was enrolled in a self-funded plan that Cigna administered ^[1][2]. She filed suit in June 2024 under Section 1557 of the Affordable Care Act, arguing that leaving out GLP-1 medicines prescribed for obesity — Wegovy and Zepbound among them — while paying for the same drugs when they were prescribed for diabetes treated members with obesity differently ^[1]. Her complaint pointed to Cigna's own internal policies, which she said treated the drugs as medically necessary for obesity ^[1].

The district court in Maine threw out the case on Feb. 12, 2025 ^[2]. It found nothing in the complaint to support the idea that the plaintiff was disabled “merely as a function of her body mass index (BMI), let alone that every putative class member with a BMI of 30 or more is presumptively … disabled,” and said she had not alleged facts showing Cigna regarded her as disabled ^[2]. The plaintiff appealed on March 19, 2025 ^[2].

The First Circuit agreed the case should end there but gave a different reason ^[1][3]. It declined to decide whether obesity itself can be a disability ^[1]. The Americans with Disabilities Act, which supplies the definition used in these cases, requires a physical or mental impairment that substantially limits one or more major life activities ^[3]. The court found the plaintiff's statements about limits on walking, standing and sleeping to be conclusory — “threadbare recitals of the elements of a cause of action” — and turned down her argument that a diagnosis of obesity plus a prescription for it automatically means major bodily functions are substantially limited ^[3].

A second case, Holland v. Elevance, was dismissed in the same district court on April 9, 2025 ^[2]. There the judge accepted that the plaintiff's obesity could count as a disability but still dismissed, because the exclusion applied to overweight and obese members alike whether or not they were disabled ^[1]. Elevance also noted that some weight-loss drugs can be covered for weight management when an employer buys that coverage and prior authorization criteria are met ^[2]. The plaintiff appealed on April 21, 2025; the First Circuit has not ruled ^[1][2].

Why it matters for patients

Plans that pay for GLP-1s for diabetes while excluding them for weight loss remain lawful after this ruling. That gap was the heart of the Cigna case: Wegovy and Zepbound were not covered for obesity, while the same drugs were covered for other conditions such as diabetes ^[1].

The decision is narrow. It does not say obesity can never be a disability. It says one complaint did not allege enough about how one person's condition limited her daily life, and both courts described disability as an individualized question rather than something established by a diagnosis or a prescription ^[2][3].

Nothing in the ruling requires any plan to add weight-loss coverage. The federal Employee Retirement Income Security Act does not require employers to offer it ^[4]. Coverage of GLP-1s for weight loss by insurers and employers has shrunk notably in recent years as spending rose ^[1]. Groom Law Group, which analyzed the district court decisions, notes the reasoning could also bear on plans covered by the ADA instead of Section 1557 ^[2]. Simplefill, a prescription assistance company, puts GLP-1 list prices between $617 and $766 a month ^[4]. The rulings do not address what patients pay when a plan excludes the drugs.

What happens next

The Elevance appeal has been before the First Circuit since April 21, 2025, and no decision date has been announced ^[2]. If that court reaches the disability question, it could answer what the Cigna panel left open ^[1]. Whether the Cigna reasoning extends to plans governed by the ADA rather than Section 1557 has not been decided ^[2].