OPM Carrier Letter 2026-07 sets plan year 2027 FEHB rules: anti-obesity medication requirement kept, intensive behavioral therapy condition added

The U.S. Office of Personnel Management issued FEHB/PSHB Carrier Letter 2026-07 on March 31, 2026, the annual "call letter" that tells Federal Employees Health Benefits and Postal Service Health Benefits carriers what OPM expects in their plans for 2027 ^[1]. For obesity drugs, the letter keeps the existing coverage floor in place but attaches a new condition: prior authorization must confirm the member is participating in structured lifestyle treatment before and during drug therapy ^[1][2].

What the letter requires

OPM says it "continues to require Carriers to provide a range of FDA-approved anti-obesity medications on their formulary, including at least one anti-obesity medication (AOM) from the GLP-1 class for weight loss and at least two (2) additional oral AOM options" ^[1]. That is the same formulary floor carriers have been working under, and it means every FEHB plan must list at least one GLP-1 weight-loss drug ^[2].

The letter also reminds carriers to cover a "comprehensive obesity management benefit" with four parts: nutrition and physical activity supports, intensive behavioral counseling, coverage of anti-obesity medications when medically indicated, and criteria for metabolic surgery ^[1].

The new piece for plan year 2027 is how utilization management is supposed to work. As quoted by Government Executive from the letter: "Prior authorization for any AOM must ensure the member has demonstrated and will continue participation in lifestyle interventions meeting the rigor of IBT before initiating treatment and while on an AOM" ^[2]. In other words, carriers are directed to tie approval and continued coverage of an anti-obesity medication to ongoing participation in intensive behavioral therapy, not just to a starting BMI number ^[2].

OPM defines IBT for obesity as three things: screening using BMI (weight in kilograms divided by height in meters squared) or waist-to-hip ratio; a dietary or nutritional assessment; and intensive behavioral counseling and therapy to promote sustained weight loss through high-intensity diet and exercise interventions ^[1]. The letter calls IBT "the primary USPSTF recommendation" and says it has shown cost savings related to physician time, medication use and obesity-related costs ^[1].

OPM grounds the policy in FDA labeling and clinical guidelines, writing that FDA indications for anti-obesity medications "reinforce that nutrition, behavioral interventions and physical activity regimens should precede drug treatment of obesity" and that these drugs "are not recommended for cosmetic or convenience weight loss" ^[1]. It cites the American Diabetes Association, the American Association of Clinical Endocrinology and the USPSTF, and points to 2025 AACE/ACE guidelines that describe shared decision-making about intensifying or de-escalating both IBT and medication ^[1].

Carriers must also cover IBT programs for children aged 6 and older with a BMI above the 95th percentile for age and sex, delivered in a primary care office or through a community-based organization ^[2].

Why it matters for patients

For roughly the federal and postal workforce and retirees enrolled in FEHB and PSHB, the headline is that GLP-1 coverage for weight loss is not going away in 2027 ^[1][2]. What could change is the paperwork and the conditions around it. If a plan follows the letter closely, getting a prescription approved may require documenting enrollment in a counseling or lifestyle program, and staying approved at refill time may require showing continued participation ^[2].

How burdensome that is will depend on each carrier's implementation, which is not yet known. Plan brochures and formularies for 2027 are not out, so the specific programs that count as "meeting the rigor of IBT," the visit frequency, and how continued participation gets verified are still open questions. Government Executive notes that carrier details matter and advises reviewing Section 2 of the official plan brochure during Open Season ^[2].

The call letter also mentions TrumpRx, a federal price-transparency effort, and encourages carriers to educate members about it. Government Executive points out that anything bought through TrumpRx is paid in cash outside the FEHB plan and does not count toward a deductible or catastrophic limit, and that prices there are not always lower than plan coverage ^[2].

What happens next

Carriers must submit benefit and rate proposals on or before 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]. Plan details then surface during fall Open Season ^[2]. OPM notes that call letter responsiveness is scored by a contracting officer as part of Plan Performance Assessment ^[1].