If you get health insurance through the federal government, you have until December 14 to choose a plan for next year, and for GLP-1s, the fine print just changed. After that: the safety questions piling up around this drug class beyond yesterday's eye warning, and a reversal in the Brazilian court fight over a city's compounded tirzepatide program. This is GLP-1 Daily for Wednesday, November 11. Coverage comes first. Follow the show and the next briefing lands in your feed on its own.
From Dose Compare, a drug-coverage comparison site, summarizing rules from the Office of Personnel Management:
For 2027, OPM requires every FEHB and PSHB plan to cover at least one GLP-1 weight-loss drug and at least two oral anti-obesity drugs, but only for members who take part in an intensive behavioral therapy (IBT) program before and during treatment (OPM Carrier Letter 2026-07).
FEHB and PSHB are the health programs for federal employees and postal workers. Open Season for 2027 started Monday, November 9, and runs through December 14. The details. Prior authorization has to show the member joined an intensive behavioral therapy program and stays in it while on the drug. OPM says a signed attestation from the member or the doctor shouldn't be enough to skip that. And one GLP-1 satisfies the rule, so a plan can list Wegovy or Zepbound, not necessarily both. So the mandate is real, and so is the gate. Mail Handlers Benefit Plan creates a tier where you pay 50 percent of the plan's allowance, and approved adults must join a CVS weight management program and stay engaged. GEHA's High Option also goes to 50 percent. Half the allowed amount can be a big number. Dose Compare suggests comparing it against the manufacturers' self-pay prices before you assume coverage is the cheaper route. And "stays engaged" is doing a lot of work. Whoever defines engagement decides who keeps the drug. If you're a federal enrollee, read Section 2 of your plan's 2027 brochure, then the drug section, and bring what you find to your prescriber before you pick a plan.
Becker's Hospital Review, in a roundup for clinicians published Tuesday:
The FDA received reports that two people died after taking illicit products claiming to be Eli Lilly’s experimental drug retatrutide. The reports are unverified, and America’s Poison Centers logged 862 exposures to retatrutide in the three months ending in September, up from 460 in the previous three months.
Retatrutide is still experimental, so these were illicit products using its name. And the poison center count nearly doubled in a quarter. Note the wording. The death reports are unverified, and Becker's doesn't say what caused them. On the eye warning we covered yesterday, Becker's counts at least 4,000 consolidated claims alleging vision loss. Drugmakers dispute a causal link. Two more items for patients. Apothecary Pharma is recalling 22 vials of compounded tirzepatide nationwide, a Class II recall, because sterility can't be assured. Becker's doesn't describe the pharmacy's registration status, so one recall tells you about those vials, not about every compounder. And a case report linked tirzepatide to lithium toxicity in a woman with bipolar disorder, the fourth reported case. Her lithium level rose from 0.7 to 1.2 within three weeks. An outside expert recommended checking lithium levels and kidney function early in treatment. If you take lithium, or anything else with a narrow dosing window, make sure whoever prescribes your GLP-1 knows. That's a five-minute conversation worth having.
Informa Noroeste, a regional Brazilian news site drawing on reporting from G1, in the original Portuguese:
O Tribunal de Justiça de São Paulo (TJSP) autorizou a Prefeitura de Urupês a retomar as aplicações de tirzepatida manipulada em pacientes com obesidade acompanhados pela rede pública. O fornecimento estava suspenso desde o fim de outubro por determinação judicial solicitada pela Eli Lilly, farmacêutica fabricante do Mounjaro. A nova decisão possui caráter provisório.
In English: São Paulo's state court has let the city of Urupês restart compounded tirzepatide injections for its public-health patients. Lilly had won a suspension in late October. This new ruling, reported Tuesday, is provisional. We led with this on November 6, when the suspension stood and the city's first appeal had failed. About 400 patients, many waiting for bariatric surgery. Lilly argued the city's purchases broke Anvisa's compounding rules. What changed: the judge accepted, for now, the city's argument that the volume in its tender was a budget estimate, not advance production, and that each preparation follows an individual, named prescription. Context: in Brazil, Mounjaro is the only tirzepatide registered with Anvisa, Lilly holds the patent through 2036, and compounding is allowed only in exceptional cases. For those 400 people, treatment can restart. But a provisional ruling can be reversed, and nobody's care plan should hang on the next hearing.
Federal employees, we want your brochure findings. Which GLP-1 does your 2027 plan list, and what's the behavioral program like? Write to glp1daily at lantern podcasts dot com.
None of this replaces a conversation with the clinician who knows your history. GLP-1 Daily is part of the Lantern Podcasts family, and we'll see you tomorrow, Thursday.