Holland v. Elevance Health, Inc.

── Holland v. Elevance Health, Inc. ── Case No.: 25-1359 Court: Court of Appeals for the First Circuit Date: March 27, 2026 Category: General United States Court of Appeals For the First Circuit No. 25-1359 REBECCA HOLLAND, on her own behalf and on behalf of those similarly situated, Plaintiff, Appellant, v. ELEVANCE HEALTH, INC., f/k/a Anthem, Inc., Defendant, Appellee. APPEAL FROM THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF MAINE [Hon. Lance E. Walker, U.S. District Judge] Before Montecalvo, Lynch, and Thompson, Circuit Judges. Anna P. Prakash, with whom Kiese T. Hansen, Nichols Kaster, PLLP, Eleanor Hamburger, Richard E. Spoonemore, Ari Robbins Greene, Sirianni Youtz Spoonemore Hamburger PLLC, Shelby Leighton, and Public Justice were on brief, for appellant. Elizabeth Parr Hecker, with whom Raymond A. Cardozo, Carol B. Lewis, Daniel J. Hofmeister, Bryan M. Webster, Alex M. Lucas, and Reed Smith LLP were on brief, for appellee. March 27, 2026  MONTECALVO, Circuit Judge. Rebecca Holland filed a putative class action against Elevance Health, Inc. ("Elevance"), alleging that it designed and administered a health insurance plan -- through its subsidiary Anthem Health Plans of Maine, Inc. ("Anthem") -- that excluded coverage for weight-loss medication (the "Exclusion").1 Holland alleged that the Exclusion violated federal law because it discriminated against plan enrollees diagnosed with obesity. The district court dismissed the matter, concluding that Holland's allegations failed to plausibly support her theories of unlawful disability discrimination. For the reasons stated below, we affirm. I. Background A. Factual Background2 As a Falmouth Public Schools employee, Holland is enrolled in a health insurance plan (the "Plan") through the Maine Education Association Benefits Trust. Anthem, a health insurance company, designed and administers the Plan. The Plan contains an exclusion in its "What's Covered" section under the heading "Bariatric Surgery / Morbid Obesity," which states, in relevant 1 Elevance Health, Inc. was formerly known as Anthem, Inc. Elevance's subsidiary, Anthem Health Plans of Maine, Inc., does business as Anthem Blue Cross and Blue Shield. 2 We take the facts from Holland's complaint and draw all reasonable inferences in her favor. Freeman v. Town of Hudson, 714 F.3d 29, 33 (1st Cir. 2013) (citing San Juan Cable, LLC v. P.R. Tel. Co., 612 F.3d 25, 28 (1st Cir. 2010)). - 2 - part, that "[b]enefits are not provided for weight loss medications." In September 2022, Holland visited Dr. Rebecca Hemphill's office "to discuss anti-obesity treatment." There, Holland met with a physician assistant who diagnosed Holland with obesity and indicated that Holland had been unable to sustain weight loss despite her diet and exercise attempts. Accordingly, the physician assistant prescribed Holland an FDA-approved weight-loss medication, Wegovy, to treat her obesity. However, Anthem denied coverage for Wegovy. When the physician assistant prescribed Holland another FDA-approved weight-loss medication, Contrave, Anthem again denied coverage. Eventually, Dr. Hemphill appealed Anthem's coverage denial for Wegovy, emphasizing Holland's eligibility for the medication, Holland's medical history, and supporting medical literature.