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Insurers hesitant to cover costly anti-obesity drugs


Many insurers are reluctant to cover weight-loss drugs--and the reason why has changed.

In the past, Medicare and private insurers hesitated to cover such drugs because of safety concerns, according to Kaiser Health News. Now, the issue is more cost-related.

Health plans will cover things that appear to have an immediate impact for that plan. "For things that are preventive in the long term, it makes plan sponsors think about their strategy," Steve Miller, the chief medical officer at Express Scripts, told KHN. So the health benefits of using such drugs to lose weight may not be immediate. 

But as the link between obesity and the increased risk for type 2 diabetes, heart disease and cancer strengthens, the use of prescription drugs increases.

In December, the Food and Drug Administration approved Saxenda. The anti-obesity drug is just the fourth obesity-fighting prescription drug the FDA has approved since 2012, noted KHN.

Individuals who are prescribed anti-obesity drugs often rely on them for the rest of their lives. This therefore poses a potential cost problem to insurers.

Currently, Miller estimates that about one-third of insurers don't cover anti-obesity drugs at all, another one-third cover all FDA-approved drugs and the remaining one-third cover such drugs but restricts the limit of their use. Medicare does not cover anti-obesity drugs, noted KHN.

Rising drug prices have been sweeping the industry as of late. With many cancer-treating drugs costing more than $100,000 a year, many insurers--who absorb most of the cost--have been trying to get pharma companies to lower the prices, FierceHealthPayer previously reported.

America's Health Insurance Plans has called out the drug industry for the soaring costs of new specialty medications, saying such expensive pricing is unsustainable and takes unfair advantage of health insurers.

For more:
- here's the KHN piece

Related Articles:
Murky preventive care rules trouble insurers, patients
60 Minutes spotlights rising drug costs
AHIP slams pharma for taking advantage of insurers
Medicaid insurers struggle to pay for pricey drugs