Advocates are fighting for weight loss coverage to no avail.
Maya Cohen, 55, of Cape Elizabeth, Maine, was concerned about being overweight and the potential health effects of this, including the high probability of developing Type 2 diabetes or a heart condition. She sought treatment with Dr. Caroline Apovian, an obesity specialist at Brigham and Women’s Hospital. Dr. Apovian prescribed Saxenda, which has been recently approved for market as a weight control drug. However, when Cohen went to fill the prescription, the pharmacy notified her that it would cost $1,500 a month because her insurance provider had labeled the drug a “vanity drug” and refused to cover it.
“I’m being treated for obesity,” she complained in a follow up communication, but it didn’t matter. The company wouldn’t budge.
Dr. Apovian said that this, unfortunately, is a common response from insurance companies when she prescribes weight loss drugs and the standard response from Medicare drug plans. It doesn’t matter to these companies and curbing growing obesity rates would help to eliminate its negative impact on health. Novo-Nordisk, the manufacturer of the medicine Dr. Apovian prescribed, and consumer advocacy groups have been lobbying insurers to pay for these types of medications and have been lobbying Congress to pass a bill required Medicare to payout.
The Centers for Disease Control and Prevention (CDC) estimates more than 40 percent of Americans have obesity and the majority of these citizens have repeatedly tried standard weight loss options (i.e., diet and exercise) to no avail. Oftentimes, other underlying medical conditions are linked to being overweight as is taking a number of drugs used to treat mental illness
“The evidence is now overwhelming that there are physical changes in weight regulating pathways that make it difficult for people to lose weight and maintain their weight loss,” said Dr. Louis Aronne, an obesity medicine specialist who and director of the weight control center at Weill Cornell Medicine. “It’s not that they don’t have willpower. Something physical is holding them back.”
“Access to medicines for the treatment of obesity is dismal in this country,” added Dr. Fatima Cody Stanford, an obesity medicine specialist at Massachusetts General Hospital and Harvard Medical School. And, Dr. Scott Kahan, an obesity medicine specialist in Washington, D.C. added that, even if doctors and patients know there are FDA approved drugs, “many think they are unsafe or not well studied and that everyone regains their weight.”
In fact, data shows only one percent of doctors in the United States are trained in obesity medicine. And those who are trained have had to find workarounds to help their patients when insurance companies refuse to pay. Oftentimes this means prescribing a medication for a coverable condition such as diabetes. For example, Novo Nordisk markets some of its drugs for both diabetes and obesity, under different names. Thus, prescribing a medication to (on paper) control diabetes (rather than mentioning weight loss) could mean it would be more affordable and allow more patients to experience its benefits.
Cohen ultimately had a substantial weight loss response to Ozempic (the diabetes drug that is equivalent to Saxenda). She has lost 54 pounds, and feels great – not to mention, she is now better able to ward off secondary effects of obesity.
“It has absolutely changed my life,” she said.