The Federal Appeals Court Just Dismissed Hundreds of Weight-Loss Drug Lawsuits. What That Means for Patients.

Being ill and impoverished at the same time can lead to a certain kind of exhaustion. When Rebecca Holland, a resident of Maine, received the denial letter from her insurance company, she likely experienced some form of that. Wegovy was prescribed to her after her doctor determined that she was obese. Her doctor prescribed a medication that cost more than $1,000 per month. None of it was covered by her employer’s Anthem plan. So she filed a lawsuit. She was also told she had no case by a federal appeals court last week.

Days after confirming the earlier dismissal of another Maine resident’s case against Cigna, the 1st U.S. Circuit Court of Appeals upheld Holland’s lawsuit against Elevance Health, the parent company of Anthem Blue Cross and Blue Shield. Both women had claimed that by refusing to pay for weight-loss drugs, their insurers were discriminating against individuals who were diagnosed with obesity, a condition that is considered a disability under the Affordable Care Act. The courts couldn’t agree. The judges reasoned that Anthem’s exclusion applies to all enrollees, not just those who are obese. No specific discrimination, no breach of the law. The case is closed.

If one were to interpret the decision in strictly technical terms, that reasoning might be valid. Insurance companies can claim they are being equally restrictive rather than selectively cruel when they deny a benefit to everyone. However, there is something about that argument that seems unsatisfactory when you sit with it for a little while. By definition, those with an obesity diagnosis are the most likely to receive a prescription for Wegovy or Ozempic. Referring to the exclusion as “broad” does not alter who is most affected by it. It simply makes the math appear more tidy.

Nonetheless, the courts have established a firm line. Chief U.S. District Judge Lance Walker, who dismissed both cases at the trial level, stated that a doctor’s willingness to prescribe a medication does not automatically render a patient legally disabled, nor does a BMI score alone establish disability under the law. There was no basis for disagreement, according to the First Circuit. The message is fairly clear for patients in similar employer-sponsored plans across the nation: there is currently no way to use discrimination laws to compel insurers to cover these medications.

The parallel universe of litigation taking place in Pennsylvania’s federal court is what makes everything seem more complicated. A different and much bigger legal battle has been developing in Philadelphia while the insurance coverage cases were being quietly dismissed in New England. As of early April 2026, MDL-3094, a multidistrict lawsuit concerning physical injuries purportedly brought on by GLP-1 medications like Wegovy, Ozempic, and Mounjaro, had consolidated over 3,500 individual claims. These policy arguments are not theoretical. These people claim that their stomachs stopped functioning, that they suddenly became blind, and that they ended up in emergency rooms with conditions they claim no one could have predicted.

The figures emerging from that Pennsylvania courtroom are startling. 75% of the lawsuits in the consolidated case, according to Novo Nordisk’s own legal filings, claim gastroparesis, or stomach paralysis, a condition in which the digestive system slows down or ceases to function. An additional 18% claim to have ileus, a related intestinal ailment. A smaller but increasing percentage of plaintiffs say they have NAION, a rare type of optic neuropathy that results in abrupt, typically irreversible vision loss. In mid-2025, the European Medicines Agency came to the official conclusion that using Wegovy doubles a person’s chance of getting this illness. Soon after, the World Health Organization issued a general warning to the public. Although the labeling was eventually updated in the US, plaintiffs contend that the warnings were too quiet and came too late.

The discrepancy between how these medications have been advertised and what this lawsuit implies was known—or at least suspected—about their risks is difficult to ignore. Wegovy and Ozempic sales were a major factor in Novo Nordisk’s controlling shareholder’s nearly twofold increase in annual revenue in 2024. By the end of 2023, the hashtag #wegovyweightloss had received over 163 million views on TikTok. The drug was being marketed as something akin to a miracle, loudly and successfully. The plaintiffs’ attorneys are now arguing in the Philadelphia courtroom that the company failed to sufficiently warn consumers while it was creating that image.

Here, it’s important to note the FDA’s own timeline. The agency sent Novo Nordisk a warning letter in March 2026 regarding its reporting of adverse drug events, noting that the company had neglected to accurately record at least two significant incidents, including one involving a patient who had a stroke and another who committed suicide. Novo Nordisk was given fifteen business days to reply with a corrective plan in the letter. That doesn’t mean the business is doing well. That is an expression of concern from a regulator regarding the availability of information regarding patient harm.

The picture that emerges is genuinely challenging for patients caught between these two legal battles: the unresolved injury claims on the one hand, and the dismissed insurance cases on the other. Individuals who cannot afford insurance are forced to pay cash or forgo coverage. The litigation process, which could take years at its current pace, is awaiting those who took the drugs and had major complications. The Pennsylvania MDL’s supervisor, Judge Karen Marston, has already made it clear that patients claiming gastroparesis will require a gastric emptying study in order to move forward. The plaintiffs’ lawyers saw this decision as a tightening of the evidentiary bar, albeit not an insurmountable one.

There’s a feeling that the legal system is dealing with something for which it wasn’t fully ready—a drug that simultaneously gained enormous popularity, enormous profit, and enormous controversy. At least in the First Circuit, the battle over insurance coverage may be over. The claims for injuries are still very much alive. And in the middle is the patient who simply needed assistance with weight loss and is now attempting to determine what went wrong with their health and who, if anyone, is to blame.