Southmoreland School District Sues Teachers Union Over Prescription Weight-Loss Drugs Coverage

Strategic Insights -

The Southmoreland School District in Westmoreland County is locked in a legal battle with its teachers union over the coverage of prescription weight-loss drugs in its health insurance plan. The dispute centers on an auditor's claim that Highmark, the district's insurer, improperly paid more than $1.9 million for medications not covered by the district's plan, including weight-loss drugs, in the previous year. The district has filed a lawsuit in Westmoreland County to overturn an arbiter's decision that sided with the union, arguing that the decision was based on incorrect medical determinations and would increase health insurance costs by 10%.

Key Takeaways:

  • The arbitration ruling ordered Southmoreland to resume coverage for weight-loss drugs if they were prescribed for other health-related purposes, but this ruling does not apply to union members in other school districts.
  • Court documents show 510 participants in Westmoreland County school districts' health plans were prescribed weight-loss drugs during the 2023-24 school year, and 410 of those participants filled prescriptions for drugs that are now excluded.
  • The Southmoreland School District argues that covering weight-loss drugs could increase health insurance costs by 10% due to high costs associated with these medications.
  • The teachers union claims that excluding weight-loss drugs is an improper alteration of the negotiated health care plan, which is in effect until 2029.
  • Highmark does not mandate clients to exclude weight-loss drugs from health care plans, but determines medical policy for its self-insured clients, which may change due to ongoing review of clinical effectiveness, safety, and efficacy.
  • Teachers claim they were forced to stop using the medications in January due to out-of-pocket costs and that their health has since deteriorated.
  • The Scottdale teachers union and the school district's lawyers have not commented on the lawsuit.

Sources:

  • "Southmoreland School District Files Lawsuit Over Prescriptions" by Rich Cholodofsky, Tribune-Review (September 17, 2025)
  • Court documents filed in Westmoreland County court
  • Email statement from Highmark spokesman Aaron Bilger
  • Statement from Highmark revising weight-loss drug coverage in 2024