OPM keeps GLP-1 weight-loss coverage rule for federal plans and ties prior authorization to behavioral therapy

The Office of Personnel Management spelled out its 2027 expectations for federal and postal health plans in Carrier Letter 2026-07, dated March 31, 2026, keeping a standing rule that carriers must include at least one GLP-1 weight-loss drug and at least two other oral anti-obesity medications on formulary ^[1]. New for plan year 2027, prior authorization and other utilization management for any anti-obesity medication must verify that the member has taken part in lifestyle interventions meeting the rigor of intensive behavioral therapy and will continue taking part while on the drug ^[1][2].

The formulary floor carries over from prior years for the Federal Employees Health Benefits (FEHB) and Postal Service Health Benefits (PSHB) programs, according to the letter and an April 6, 2026 analysis by Government Executive ^[1][2]. OPM also repeated its expectation that carriers field a full obesity benefit with four parts: nutrition and physical activity supports, intensive behavioral counseling, anti-obesity drugs when medically indicated, and criteria for metabolic surgery ^[1].

OPM defines intensive behavioral therapy as screening for obesity in adults through body mass index or waist-to-hip ratios, a nutrition assessment, and intensive counseling and behavioral therapy aimed at sustained weight loss through high-intensity work on diet and exercise ^[1][2]. The letter cites the U.S. Preventive Services Task Force, whose main healthy-weight recommendation is intensive behavioral therapy, and says that approach has shown savings tied to physician time, medication use and obesity-related costs ^[1]. It also points to FDA drug guidance stating that nutrition, behavioral interventions and physical activity should come before drug treatment of obesity and that these medicines are not recommended for cosmetic or convenience weight loss ^[1].

Children get a mention too. Government Executive reported that carriers must cover intensive behavioral therapy for children age 6 and older with a body mass index above the 95th percentile for their age and sex, delivered in a primary care office or a community organization ^[2]. The letter directs carriers to cover the full extent of USPSTF recommendations on healthy weight for adults, children, adolescents and pregnant women ^[1].

Several specifics are not yet known. The letter does not name products, so beyond the minimum of one GLP-1 weight-loss drug, which brands an individual plan lists for 2027 has not been disclosed ^[1]. Nor does the letter say what paperwork, program format or provider type carriers must accept as proof of participation in intensive behavioral therapy ^[1][2].

Why it matters for patients

For someone on FEHB or PSHB who takes or is considering an anti-obesity medication, the 2027 rules mean coverage may hinge on documented enrollment in a structured lifestyle program, not just a prescription. Each carrier writes its own prior authorization criteria, and the letter now requires those criteria to confirm both past and continuing participation before and during treatment ^[1][2].

The formulary rule sets a minimum, not a guarantee. A plan must carry at least one GLP-1 weight-loss drug and two oral options, but whether a particular plan covers a given product such as Wegovy (semaglutide) or Zepbound (tirzepatide) in 2027 has not been disclosed ^[1].

Government Executive noted that federal employees whose FEHB plan denies a GLP-1 weight-loss drug can buy some of these medicines through TrumpRx, paying cash outside the plan; those purchases do not count toward a deductible or catastrophic limit and may cost more than the plan price ^[2]. OPM urges carriers to educate members about price transparency ^[2].

What happens next

Benefit and rate proposals are due from carriers by May 31, 2026, for the contract term starting January 1, 2027 ^[1]. OPM expects to finish benefit negotiations by July 31, 2026, and rate negotiations by mid-August ^[1]. Open Season in the fall is when enrollees compare plans, and the 2027 brochures and drug lists will show how each carrier applied the behavioral therapy condition ^[2].