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

• Published in: International Journal of Obesity 2018-03, Vol.42 (3), p.495-500
• Main Authors: Gomez, G, Stanford, F C
• Format: Article
• Language: English
• Subjects: 692/308/174; 692/699/2743/393; 692/700/1538; 692/700/155; Anti-obesity agents; Anti-Obesity Agents - economics; Anti-Obesity Agents - therapeutic use; Behavior modification; Chronic illnesses; Drug therapy; Epidemiology; FDA approval; Gastrointestinal surgery; Government programs; Health care policy; Health insurance; Health policy; Health Promotion and Disease Prevention; Health risks; Humans; Insurance; Insurance coverage; Internal Medicine; Laws, regulations and rules; Medicaid - statistics & numerical data; Medicare; Medicare - statistics & numerical data; Medicine; Medicine & Public Health; Metabolic Diseases; Naltrexone; Obesity; Obesity - drug therapy; Obesity - economics; original-article; Patient Protection and Affordable Care Act - statistics & numerical data; Pharmacology; Prescription drugs; Prescriptions - economics; Prescriptions - statistics & numerical data; Public Health; Regulatory agencies; Surgery; Topiramate; United States
• ISSN: 0307-0565; 1476-5497; 1476-5497
• DOI: 10.1038/ijo.2017.287

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.