Feds with Benefits: Does FEHB cover weight loss medications?

September: Time for cooler weather, pumpkin spice lattes, and the return of college football.

Besides those early fall traditions, it’s also when we’ll get our first glimpse at the upcoming Federal Employee Health Benefits Open Season. The Office of Personnel Management will issue their annual press release that will provide information on premium rates, available plans, and new and expanded benefits for next year. I’ll cover what’s new for 2025 in our next Feds with Benefits column in early October.

Keep submitting your FEHB questions! I’ve enjoyed learning about the issues you’d like more information on, and we’ll include some answers to submitted questions, like the one below, in future columns.

Question: When will weight loss medications be covered?

As part of their initiative to prevent and treat obesity, OPM has required FEHB carriers to cover at least one GLP-1 drug for weight loss since early 2023.

To see which prescription drugs your plan covers, go to the plan website and look for the prescription drug formulary. Currently, depending on the FEHB plan, you’ll find a range of presentation styles, from 100-page PDFs to online lookup tools that allow you to select your prescription drug, dosage and pharmacy before you’re shown cost and coverage details. Prescription drug research should be much easier this upcoming Open Season; OPM announced earlier this year that carriers should provide current and prospective plan members prescription drug transparency tools that accurately reflect the formulary and member cost share.

One other aspect of weight-loss drugs worth mentioning is Part D coverage. Last year, OPM allowed FEHB carriers to begin offering Part D prescription (PDP) drug plans to Medicare-eligible enrollees. Seventeen FEHB plans auto-enrolled their Medicare members into a PDP, and more may offer these for plan year 2025. To receive OPM approval, the PDP combined with FEHB program coverage must be equal to or better than what’s available through the FEHB plan coverage alone. That means you won’t lose access to GLP-1 weight-loss drugs since the FEHB plan must maintain coverage for that drug class. This differs from commercial Part D plans that only provide coverage for GLP-1 weight loss drugs when prescribed for another condition, such as diabetes or to prevent heart disease.

Kevin Moss is a senior editor with Consumers’ Checkbook. Watch more of his free advice and check if the Guide to Health Plans for Federal Employees is available for free from your agency. You can also purchase the Guide and save 20% with promo code FEDNEWS.

Have a question about your benefits? Submit your question to Kevin for the chance to have it answered in a future column.

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