Do federal employee health plans cover GLP-1s? (FEP Blue)

Ozempic and Mounjaro (type 2 diabetes)

Covered with restrictions. FEP's 2026 formulary places both Ozempic and Mounjaro at Tier 2 with a prior approval marker on Standard, Basic and Focus. Medical policy 5.30.086 (effective 7/1/2026) requires a type 2 diabetes diagnosis (HbA1c 6.5% or higher or equivalent lab evidence), bars use with another GLP-1, and approves for 12 months. No metformin step is listed in the policy.

Applies to: FEP Blue Standard, Basic and Focus (federal employee plans); type 2 diabetes

Source: FEP Blue Medical Policy 5.30.086 Antidiabetic GLP-1/GIP Agonists, Effective 2026-07-01

Wegovy

Covered with restrictions. FEP's 2026 formulary lists Wegovy at Tier 3 with prior approval on Standard and Basic. FEP policy 5.99.030 requires age 12 or older, chronic weight management with BMI 30+ (or 27+ with CV disease or a comorbidity; pediatric at or above the 95th percentile), participation in a comprehensive weight management program, and no other GLP-1 use. Initial approval is 6 months and renewal needs at least 5% weight loss or maintenance. Coverage under the Focus option differs, so check the 2026 FEP Blue formulary for your option.

Applies to: FEP Blue Standard and Basic (federal employee plans); chronic weight management with prior approval

Source: FEP Blue Medical Policy 5.99.030 Saxenda/Wegovy (with 2026 Abbreviated Formulary), Policy effective 2025-01-01; formulary 2026; Caremark form revised 2026-09-18

Zepbound

FEP's 2026 abbreviated formulary lists Zepbound among excluded weight-loss drugs on all options, and the pharmacy FAQ shows it only as a formulary-exception drug (Tier 3 on Standard and Basic, Tier 2 on Focus). Policy 5.99.031 (effective 7/1/2026) requires age 18 or older, BMI 30+ (or 27+ with comorbidity), an inadequate response, intolerance or contraindication to at least two oral weight-loss drugs (benzphetamine, diethylpropion, phentermine, Qsymia), a weight management program, and no other GLP-1. Renewal requires 5% weight loss.

Applies to: FEP Blue Standard, Basic and Focus. Excluded from the 2026 formularies; available only through a formulary exception. If an exception is approved, Zepbound is Tier 3 (non-preferred) on Standard and Basic and Tier 2 (preferred) on Focus.

Source: FEP Blue Medical Policy 5.99.031 Zepbound (tirzepatide) (with 2026 Abbreviated Formulary and pharmacy FAQ), Policy effective 2026-07-01; formulary 2026

How to request an exception

Your provider must submit a formulary exception request. Providers can download the form from the FEP Blue pharmacy FAQ or call 1-877-727-3784 (Traditional) or 1-855-344-0930 (MPDP). Even if the exception is approved, you cannot request a tier exception.

Source: FEP Blue, Pharmacy FAQ, checked October 5, 2026