US health policy and prescription drug coverage of FDA-approved medications for the treatment of obesity

Int J Obes (Lond). 2018 Mar;42(3):495-500. doi: 10.1038/ijo.2017.287. Epub 2017 Nov 20.

Abstract

Objective: Obesity is now the most prevalent chronic disease in the United States, which amounts to an estimated $147 billion in health care spending annually. The Affordable Care Act (ACA) enacted in 2010 included provisions for private and public health insurance plans that expanded coverage for lifestyle/behavior modification and bariatric surgery for the treatment of obesity. Pharmacotherapy, however, has not been included despite their evidence-based efficacy. We set out to investigate the coverage of Food and Drug Administration-approved medications for obesity within Medicare, Medicaid and ACA-established marketplace health insurance plans.

Methods: We examined coverage for phentermine, diethylpropion, phendimetrazine, Benzphentamine, Lorcaserin, Phentermine/Topiramate (Qysmia), Liraglutide (Saxenda) and Buproprion/Naltrexone (Contrave) among Medicare, Medicaid and marketplace insurance plans in 34 states.

Results: Among 136 marketplace health insurance plans, 11% had some coverage for the specified drugs in only nine states. Medicare policy strictly excludes drug therapy for obesity. Only seven state Medicaid programs have drug coverage.

Conclusions: Obesity requires an integrated approach to combat its public health threat. Broader coverage of pharmacotherapy can make a significant contribution to fighting this complex and chronic disease.

MeSH terms

  • Anti-Obesity Agents / economics*
  • Anti-Obesity Agents / therapeutic use*
  • Humans
  • Medicaid / statistics & numerical data
  • Medicare / statistics & numerical data*
  • Obesity / drug therapy*
  • Obesity / economics
  • Patient Protection and Affordable Care Act / statistics & numerical data*
  • Prescriptions / economics
  • Prescriptions / statistics & numerical data*
  • United States

Substances

  • Anti-Obesity Agents