Enforcing Second Class Status for Obesity
Some health insurance plans seem to be panicking. For years, the order of things was simple. People with obesity had only themselves to blame and besides, nothing could be done about their condition. So health insurers routinely denied coverage for medical care of obesity. “Regardless of any potential medical benefit” was the language written into many policies. But the ground is shifting. Advanced medicines for obesity are much more effective and insurers are resorting to some thuggish tactics to enforce second class status for people with obesity.
Lately, obesity medicine physicians have been receiving threatening letters from insurers, scolding them for treating patients with obesity. A sample of those letters, shared with us, reads:
“The Special Investigations Unit has completed a comprehensive review of your prescription and professional claims. Our records show for the members you prescribed Ozempic in 2022, on average, 62% did not have sufficient evidence to support a diabetes diagnosis…We will continue to monitor…and will refer any concerns…to the state licensure board, federal and/or state law enforcement.”
Special Investigations Unit?
These letters offer no explanation for their so-called “Special Investigations Unit.” They include caveats, perhaps to excuse the not-so-veiled threats in these letters. “Our Unit is not drawing any conclusions based on this review and is not seeking any other information at this time.”
Desperate to Enforce a Line Between Diabetes and Obesity
A theme in these letters is that this insurer doesn’t like prescriptions for Ozempic in people who don’t have diabetes. Ozempic is a brand of semaglutide sold specifically for diabetes. The same drug at a slightly higher dose sells under the brand name of Wegovy for a much higher price. So some drug plans cover Ozempic but not Wegovy.
But because Ozempic contains the same active drug as Wegovy, it most often works just fine for people who need obesity treatment. But these health insurers insist on enforcing second class status for people with obesity and deny them coverage for their condition.
Thuggish Behavior, All About Greed
Let’s be clear. These tactics by health insurers are heinous. The former chair of the Obesity Action Coalition, Patty Neece, tells us “this seems like clear discrimination against people with obesity.” Obesity Medicine Association President Angela Fitch adds that “intimidating clinicians with this threatening language can have no justification.”
Such thuggish behavior seems to reflect the desperation that insurers are feeling as they realize that their customers are no longer willing to accept denial of care for a condition that profoundly affects their lives and their health. Not when highly effective medicines are available. So they perceive a threat to their profits.
Rather than negotiating lower costs with the makers of these drugs or developing evidence-based guidelines for authorizing coverage, they’re sending out threats to physicians who would dare to care.
This is simply the wrong way to go.
Click here, here, and here for further perspective on health insurance and the new obesity medicines.
Keep the Light on Oppression, photograph by Alan Levine / Wikimedia Commons
Subscribe by email to follow the accumulating evidence and observations that shape our view of health, obesity, and policy.
May 26, 2023
