Office of Personnel Management Requires Health Plans Covering Federal Employees to have Adequate Coverage for AOMs starting in 2023

In a February 17, 2022 carrier letter, the Federal Office of Personnel Management (OPM) spelled out specific guidance for health insurance carriers that administer Federal Employee Health Benefit (FEHB) plans — "clarifying that FEHB Carriers are not allowed to exclude anti-obesity medications from coverage based on a benefit exclusion or a carve out”… and that "FEHB Carriers must have adequate coverage of FDA approved anti-obesity medications (AOMs) on the formulary to meet patient needs and must include their exception process within their proposal.”
 
In rolling out this new guidance, OPM is quite clear — emphasizing that "obesity has long been recognized as a disease in the US that impacts children and adults"… and that "obesity is a complex, multifactorial, common, serious, relapsing, and costly chronic disease that serves as a major risk factor for developing conditions such as heart disease, stroke, type 2 diabetes, renal disease, non-alcoholic steatohepatitis, and certain types of cancer.”
 
In 2014, OPM encouraged carriers to cover obesity treatments and prohibited plans from excluding coverage based on the carrier’s belief that obesity is a lifestyle condition or that treatment is cosmetic. Despite this nudge from OPM for FEHB Carriers to get their act together, many plans continue to exclude or carve out coverage for AOMs. Many leaders from the Obesity Care Continuum and STOP Obesity Alliance who have worked with OPM for nearly a decade on this issue are hopeful that this new guidance will have a catalytic effect on other public and private health plans to provide comprehensive coverage for obesity care.