As the popularity of GLP-1 medications continues to rise and the list of conditions being treated with these medications grows, plan sponsors are taking a closer look at the costs and benefits of GLP-1 coverage. Many plan sponsors have concluded that they want to limit their coverage of GLP-1s to only diabetes, and not weight loss or other conditions. To limit GLP-1 coverage, a common approach is to add “weight loss medications” or “non-surgical obesity treatments” to the list of the plan’s coverage exclusions. But are these simple exclusions enough to limit your plan’s coverage of GLP-1s?

A recent federal court case (Hamburger v. Blueshield, No. 1:25-cv-03000 (TNM) (D.D.C. June 10, 2026)) offers some comfort to plan sponsors that these simple exclusions may be enough for now. 

In a case of first impression, the U.S. District Court for the District of Columbia dismissed a potential class action against the plan administrator and claims administrator for an employer-sponsored health plan, as part of which the plaintiff had argued that the FDA’s authorization of Zepbound to treat obstructive sleep apnea (“OSA”) removed it from the plan’s exclusion for weight loss medications. The court disagreed and concluded that the claims administrator had properly denied coverage for Zepbound to treat OSA. 

In this case, the plaintiff asserted claims for denial of benefits under ERISA § 502(a)(1)(B) and breach of fiduciary duty under ERISA § 502(a)(3). To support coverage of Zepbound, the plaintiff argued that the FDA has authorized Zepbound to treat OSA, which was a separate covered medical condition under the plan, and therefore that the use of the drug to treat this condition trumped the plan’s exclusion of ‘weight-loss drugs’. In denying the plaintiff’s claims, the court focused on the wording of the FDA approvals, which stated that Zepbound aids sleep apnea “by reducing body weight.” Based on this express FDA language, the court reasoned that Zepbound improves OSA “because it promotes weight loss, not as a separate, unrelated benefit,” and concluded that Zepbound is a weight-loss drug that was excluded under the terms of the plan. In reaching its holding, the court differentiated coverage of similar GLP-1 medications for treatment of diabetes, pointing out that those similar GLP-1 medications have been FDA approved specifically to treat diabetes, regardless of whether the person is also obese.

The plaintiff also attempted to claim that medical necessity should override the plan’s exclusion, but the court concluded that the claims administrator had no obligation to consider medical necessity because the coverage denial in this case was based on express plan language rather than medical judgment. 

More lawsuits can be expected as group health plan participants seek coverage for usage of GLP-1 medications for a broadening range of conditions, but this recent case should give some comfort to those plan sponsors who are relying on a simple weight loss or obesity drug exclusion to limit their liability exposure under their plans.

The Nelson Mullins Employee Benefits Group is ready to assist with questions or to discuss your options. Please contact one of our Employee Benefits attorneys or the Nelson Mullins attorney with whom you work.