A federal appeals court has handed a win to Cigna, affirming the dismissal of a class action lawsuit that alleged the insurer’s exclusion of weight loss drug coverage amounted to disability discrimination against members with obesity.
The U.S. Court of Appeals for the First Circuit issued its ruling Feb. 19, upholding a lower court’s dismissal of the complaint last year.
The plaintiff, an employee at the University of Maine enrolled in a Cigna-administered health plan, sued the insurer in June 2024 under Section 1557 of the ACA. The complaint argued that Cigna’s exclusion of GLP-1s prescribed for obesity, including Wegovy and Zepbound, was illegal disability discrimination, since the same drugs were covered under Cigna plans for other conditions such as diabetes. The complaint also noted that Cigna’s own internal policies recognized the drugs as medically necessary for treating obesity.
The First Circuit affirmed the dismissal but on different grounds than the district court. Rather than addressing whether obesity can qualify as a disability, the appeals court held that the complaint failed to prove that obesity “substantially limits” major life activity.
The ruling is the latest in a string of losses for plaintiffs attempting to use the ACA’s anti-discrimination provisions to force insurers to cover GLP-1 medications for treating obesity. Insurer and employer coverage of GLP-1s for weight loss has contracted sharply in recent years amid rising costs.
A companion case against Elevance Health in the same district court was dismissed in April 2025 on similar grounds. The case is also on appeal before the First Circuit and has not yet been decided. The district court in that case found that the plaintiff’s obesity could qualify as a disability, but still dismissed the case because the weight loss drug exclusion applied equally regardless of disability status.
