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Clinical Studies and Practice

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

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.

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Acknowledgements

Author contributions

GG and FCS participated in concept, study design and manuscript preparation. GG collected the data and completed the statistical analysis.

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Correspondence to F C Stanford.

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The authors declare no conflict of interest.

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Gomez, G., Stanford, F. US health policy and prescription drug coverage of FDA-approved medications for the treatment of obesity. Int J Obes 42, 495–500 (2018). https://doi.org/10.1038/ijo.2017.287

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