Original Article

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

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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 FDA-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 9 states. Medicare policy strictly excludes drug therapy for obesity. Only 7 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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Author information

Affiliations

  1. Department of Surgery-Urology, Brigham and Women’s Hospital; Harvard Medical School, Boston, MA, USA

    • G Gomez
  2. Weight Center, Gastrointestinal Unit-Department of Medicine, Massachusetts General Hospital, Boston, MA, USA

    • F C Stanford
  3. Department of Pediatrics- Endocrinology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    • F C Stanford

Authors

  1. Search for G Gomez in:

  2. Search for F C Stanford in:

Corresponding author

Correspondence to F C Stanford.