Many Insurers Do Not Cover Drugs Approved To Help People Lose Weight

Many Insurers Do Not Cover Weight Loss DrugsDespite the increasing efforts to fight the obesity epidemic and the approval of four new weight-loss medications, Medicare and many private plans are reluctant to pay for the medicines because of serious safety problems with other drugs in the past.WebMD News from Kaiser Health News

By Michelle Andrews

Tue, Jan 6 2015

In December, the Food and Drug Administration approved a new anti-obesity drug, Saxenda, the fourth prescription drug the agency has given the green light to fight obesity since 2012. But even though two-thirds of adults are overweight or obese — and many may need help sticking to New Year’s weight-loss resolutions — there’s a good chance their insurer won’t cover Saxenda or other anti-obesity drugs.

The health benefits of using anti-obesity drugs to lose weight—improvements in blood sugar and risk factors for heart disease, among other things—may not be immediately apparent. “For things that are preventive in the long term, it makes plan sponsors think about their strategy,” says Dr. Steve Miller, the chief medical officer at Express Scripts, which manages the prescription drug benefits for thousands of companies. Companies with high turnover, for example, are less likely to cover the drugs, he says.

“Most health plans will cover things that have an immediate impact in that plan year,” Miller says.

Miller estimates that about a third of companies don’t cover anti-obesity drugs at all, a third cover all FDA-approved weight-loss drugs, and a third cover approved drugs, but with restrictions to limit their use. The Medicare prescription drug program specifically excludes coverage of anti-obesity drugs.

Part of the reluctance by Medicare and private insurers to cover weight-loss drugs stems from serious safety problems with diet drugs in the past, including the withdrawal in 1997 of fenfluramine, part of the fen-phen diet drug combination that was found to damage heart valves.

Back then, weight-loss drugs were often dismissed as cosmetic treatments. But as the link between obesity and increased risk for type 2 diabetes, heart disease, cancer and other serious medical problems has become clearer, prescription drugs are seen as having a role to play in addressing the obesity epidemic. Obesity accounts for 21 percent of annual medical costs in the United States, or $190 billion, according to a 2012 study published in the Journal of Health Economics.

The new approved drugs — Belviq, Qsymia, Contrave and Saxenda — work by suppressing appetite, among other things. Saxenda is a subcutaneous injection, the other three drugs are in pill form. They’re generally safer and have fewer side effects than older drugs. In conjunction with diet and exercise, people typically lose between 5 and 10 percent of their body weight, research shows, modest weight loss but sufficient to meaningfully improve health.

// Pulling Third Party Info from XMLfunction getPubType() { return "third_party" } var pubSource = 'Kaiser Health News';// init check partners pluginrequirejs(['article/1/checkpartners'],function(){});// init webmdArticle pluginrequirejs(['article/1/article'],function(){$('#dyn-art').webmdArticle({pageData: {title: "Many Insurers Do Not Cover Weight Loss Drugs", imgPath: "", caption: "", description: "Despite the increasing efforts to fight the obesity epidemic and the approval of four new weight-loss medications, Medicare and many private plans are reluctant to pay for the medicines because of serious safety problems with other drugs in the past.", type: "article"}, shareTypes:{email: {htmlTemplate: 'Email'}}, shareText: '', expandIcons: {html: {more: 'More', less: 'Less'}, position: 3}});});

Web-based services, retail clinics and more.

Are you making any of these common errors?

View the original article here