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Clinical Studies and Practice

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

International Journal of Obesity volume 42, pages 495–500 (2018)Cite this article

Subjects

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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References

  1. Hales CM, Fryar CD, Ogden CL . Prevalence of Obesity Among Adults and Youth: United States, 2015–2016. National Center for Health Statistics: Hyattsville, MD, 2017.

    Google Scholar 

  2. Flegal KM, Kruszon-Moran D, Carroll MD, Fryar CD, Ogden CL . Trends in obesity among adults in the United States, 2005 to 2014. JAMA 2016; 315: 2284–2291.

    Article  CAS  Google Scholar 

  3. Heron M. Deaths: leading causes for 2014. Reports NVS, vol. 65, issue 5. National Center for Health Statistics: Hyattsville, MD, 2016, pp 1–96..

  4. Winterfield A, Cauchi R . Obesity: progress and challenges. In: Legisbrief. National Conference of State Legislatures: Washington, DC, 2014, http://www.ncsl.org/research/health/obesity-progress-and-challenges.aspx.

    Google Scholar 

  5. Kahan S, Zvenyach T . Obesity as a disease: current policies and implications for the future. Curr Obes Rep 2016; 5: 291–297.

    Article  Google Scholar 

  6. Apovian CM, Aronne LJ, Bessesen DH, McDonnell ME, Murad MH, Pagotto U et al. Pharmacological management of obesity: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 2015; 100: 342–362.

    Article  CAS  Google Scholar 

  7. Thomas CE, Mauer EA, Shukla AP, Rathi S, Aronne LJ . Low adoption of weight loss medications: a comparison of prescribing patterns of antiobesity pharmacotherapies and SGLT2s. Obesity 2016; 24: 1955–1961.

    Article  Google Scholar 

  8. Cauchi R . Health Reform and Health Mandates for Obesity. National Conference of State Legislatures: Washington, DC, 2016.

    Google Scholar 

  9. Yang YT, Pomeranz JL . States variations in the provision of bariatric surgery under affordable care act exchanges. Surg Obes Relat Dis 2015; 11: 715–720.

    Article  Google Scholar 

  10. Colman E . Food and Drug Administration's Obesity Drug Guidance Document. Circulation 2012; 125: 2156–2164.

    Article  Google Scholar 

  11. Daneschvar HL, Aronson MD, Smetana GW . FDA-approved anti-obesity drugs in the United States. Am J Med 2016; 129: 879.e1–879.e6.

    Article  CAS  Google Scholar 

  12. Butsch WS . Obesity medications: what does the future look like? Curr Opin Endocrinol Diabetes Obes 2015; 22: 360–366.

    Article  CAS  Google Scholar 

  13. Foundation KF.State health insurance marketplace types: In: Source: Data compiled through review of state legislation and other Marketplace document by Kaiser Family Foundation: KFF, 2016.

  14. Services USDoHaH Health Insurance Marketplaces 2016 Open Enrollment Period: Final Enrollment Report. Washington, DC, 2016.

  15. Plan Selection by Zip Code and County inealth Insurance Marketplace: March 2016. U.S.: Department of Health and Human Services: Washington, DC, 2016.

  16. 2016 QHP Landscape Data. In: HealthCare.gov: Centers for Medicare and Medicaid Services, 2016.

  17. Services DoHaH (ed.). 42 CFR Parts 400, 403, 411, 417, and 423 Medicare Program; Medicare Prescription Drug Benefit; Final Rule. Federal Register: Washington, DC, 2005, pp 4193–4742..

  18. Tudor C . Medicare Prescription Drug Benefit Manual—Chapter 5 Update. Services DoHaH, Center for Medicare and Medicaid Services: Baltimore, MD, 2011.

    Google Scholar 

  19. Prescription drug coverage—general information. In: Medicare. Center for Medicare and Medicaid Services, Baltimore, MD, 2016.

  20. Prescription drugs. In: Medicaid Benefits. Centers for Medicare and Medicaid Services: Baltimore, MD, 2016.

  21. Excluded drug coverage. In: Prescription Drugs. Centers for Medicare and Medicaid Services: Baltimore, MD, 2016.

  22. Medicaid Managed Care Key Data, Trends, and Issues. Kaiser Commission on Medicaid and the Uninsured: Washington, DC, 2012.

  23. Medicare Prescription Drug Benefits Manual—Chapter 6. In: Medicare Part D. Department of Health and Human Services: Baltimore, MD, 2016.

  24. Leading causes of death, 2014. In: FastStats. CDC National Center for Health Statistics: Atlanta, GA, 2015.

  25. BRFSS prevalence and trends data. Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Population Health: Atlanta, GA, 2015.

  26. Baum C, Andino K, Wittbrodt E, Stewart S, Szymanski K, Turpin R . The challenges and opportunities associated with reimbursement for obesity pharmacotherapy in the USA. Pharmacoeconomics 2015; 33: 643–653.

    Article  Google Scholar 

  27. Dietz WH, Solomon LS, Pronk N, Ziegenhorn SK, Standish M, Longjohn MM et al. An integrated framework for the prevention and treatment of obesity and its related chronic diseases. Health Aff 2015; 34: 1456–1463.

    Article  Google Scholar 

  28. Gotthardt JD, Bello NT . Can we win the war on obesity with pharmacotherapy? Expert Rev Clin Pharmacol 2016; 1–9.

  29. Courcoulas AP, Belle SH, Neiberg RH et al. Three-year outcomes of bariatric surgery vs lifestyle intervention for type 2 diabetes mellitus treatment: a randomized clinical trial. JAMA Surg 2015; 150: 931–940.

    Article  Google Scholar 

  30. Stanford FC, Alfaris N, Gomez G, Ricks ET, Shukla AP, Corey KE et al. The utility of weight loss medications after bariatric surgery for weight regain or inadequate weight loss: a multi-center study. Surg Obes Relat Dis 2017; 13: 491–500.

    Article  Google Scholar 

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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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Authors and Affiliations

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

    G Gomez

  2. Department of Medicine, Weight Center, Gastrointestinal Unit, 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

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  1. G Gomez
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  2. F C Stanford
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Corresponding author

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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