News Flash: No More Obesity Exclusions in Federal Plans

Joe Nadglowski, CEO of the Obesity Action Coalition (OAC), reports today that obesity exclusions are no longer permissible in health plans for federal employees. The text of a ruling by the Office of Personnel Management (OPM) focuses on obesity medicines, but the rationale was more sweeping. In a memo to all insurance carriers for the Federal Employees Health Benefits Program, OPM said:

We want to clarify that excluding weight loss drugs from FEHB coverage — on the basis that obesity is a “lifestyle” condition and not a medical one or that obesity treatment is “cosmetic” — is not permissible. In addition, there is no prohibition for carriers to extend coverage to this class of prescription drugs, provided that appropriate safeguards are implemented concurrently to ensure safe and effective use.

Diet and physical activity regimens should accompany drug treatment of obesity. We strongly encourage plans to review medical policies to ensure that weight loss drug therapy is delivered in conjunction with these mainstays.

Commenting on this news, Nadglowski said:

This decision came following conversations between OAC and OPM about obesity treatment benefits in multi-state plans under the Affordable Care Act. This is significant because federal employee health benefits are often seen as an important benchmark by other plans. Donna Ryan, Past President of the Obesity Society, played a key role in assembling the evidence that OAC provided to OPM to support this decision.

It’s worth noting that this is the start, not the end of the process. These changes will go into effect for the 2015 benefit plan year. Progress on this front, however incremental, is great to see.

“Coming together is a beginning; keeping together is progress; working together is success.” — Henry Ford

Click here to read the guidance from OPM.

Flash! Photograph © Eddy Van 3000 / flickr

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