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Int J Obes (Lond). 2018 Mar;42(3):495-500. doi: 10.1038/ijo.2017.287. Epub 2017 Nov 20.

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

Author information

1
Department of Surgery-Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
2
Weight Center, Gastrointestinal Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
3
Department of Pediatrics-Endocrinology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.

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.

PMID:
29151591
PMCID:
PMC6082126
DOI:
10.1038/ijo.2017.287
[Indexed for MEDLINE]
Free PMC Article

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