The Entrance to the Village

Federal Health Plans Opening Up to Obesity Care

This is good news that is both big and very welcome. In 2023, health plans for federal employees will likely open up to obesity care more than ever before. In its call for proposals to carriers that provide these health plans, the U.S. Office of Personnel Management (OPM) is quite clear:

“Obesity has long been recognized as a disease in the US that impacts children and adults. Obesity is a complex, multifactorial, common, serious, relapsing, and costly chronic disease that serves as a major risk factor for developing conditions such as heart disease, stroke, type 2 diabetes, renal
disease, non-alcoholic steatohepatitis, and certain types of cancer.”

More Explicit Guidance

The office emphasizes the impact of obesity on health equity, harm from COVID-19, and on children and adolescents. Since 2014, OPM has told carriers that they could not use lame excuses of obesity being a “lifestyle disease” to exclude coverage for anti-obesity medicines.

But now OMP is being more explicit:

“OPM is clarifying that FEHB Carriers are not allowed to exclude anti-obesity medications from coverage based on a benefit exclusion or a carve out. FEHB Carriers must have adequate coverage of FDA approved anti-obesity medications on the formulary to meet patient needs and must include their exception process within their proposal.”

In technical guidance, the office is providing considerable detail about obesity. For example, it highlights the need to address obesity in children and adolescents with comprehensive care models. OPM is also asking health plans to develop education and communication outreach to improve obesity care. This includes efforts to promote access to care, improve quality of care, and reduce weight bias in their health systems.

Thrilling Progress

Donna Ryan, a past president of both the Obesity Society and the World Obesity Federation, is thrilled with this progress. In briefing people from OPM on the science of obesity, she saw their dedication to getting this right:

“The people of this office are impressive. They had a genuine interest in providing the best healthcare for federal employees. Of course, that means covering the treatment of this disease as they would any other. They made the right decisions for the right reasons. Because  science supports an understanding that obesity is a chronic disease. It deserves the same treatment as any other chronic disease.”

Likewise, OAC President Joe Nadglowski tells us this progress is great news:

“I remember in 2014, when OPM started telling carriers that they needed to do better in covering obesity care. It turned out that a gentle nudge was not enough to fix the problem. Now, the office seems to be much more specific and directive.

“I believe we will see a lot of progress because of this and it will have spillover effects for health plans in the private sector.”

Good news has been rare lately. But it’s always welcome.

Click here for the OPM call for proposals on federal employee health benefits and here for the more detailed technical guidance. For further perspective on the importance of access to obesity care in health plans, click here and here.

The Entrance to the Village, painting by Roger de La Fresnaye / WikiArt

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March 18, 2022

5 Responses to “Federal Health Plans Opening Up to Obesity Care”

  1. March 18, 2022 at 8:36 am, Anthony Fabricatore said:

    “Thrilling progress” indeed!

    Are there historical examples of OPM decisions influencing health plans beyond FEHB? Regardless, this is fantastic news that will very likely improve the health and quality of life of many federal employees.

    Thanks for sharing.

    • March 18, 2022 at 1:41 pm, Ted said:

      I’m not sure how to document a domino effect of influence like that. I suppose it’s a form of familiarity bias.

  2. March 18, 2022 at 1:07 pm, Allen Browne said:

    Very interesting.

    How does one get to the 2022 Technical Guidance with details about obesity in children and adolescents?

    Allen

    • March 18, 2022 at 1:39 pm, Ted said:

      They haven’t published it yet, Allen, though they issued it this week.

  3. March 18, 2022 at 3:27 pm, Walter Lindstrom said:

    This is a fantastic development and I am very excited about the possibility of expanded access to all appropriate forms of obesity treatment