Drug coverage and treatment conditions must be read together
For 2027, all FEHB and PSHB carriers will require documented participation in an evidence-based intensive behavioral therapy program before and during anti-obesity medication treatment, according to OPM. Plans continue to cover at least one GLP-1 anti-obesity medication and at least two oral anti-obesity medications.
The announcement does not promise every brand is covered or that a prescription alone clears the new requirement. The plan brochure, drug formulary and applicable clinical criteria still determine a particular treatment pathway. Weight-management use and other medical indications should not be assumed to have identical coverage rules.
Verify the plan pathway before budgeting
OPM expects plans to cover specified individual and group intensive behavioral therapy and medical nutrition therapy, including 12-22 therapy sessions per year depending on progress. Carriers must coordinate those services with medication and metabolic surgery criteria. This is not a universal fixed session allowance for every patient.
Before estimating next-year costs, check the plan network, required documentation and timing with the carrier and treating clinician. Do not stop or change prescribed treatment based on a news summary. The new documentation condition is separate from premiums and does not guarantee zero out-of-pocket medication costs.