Incentives for Metabolic Surgery in Response to GLP-1 Medicines

Over the past year, as the world has embraced GLP-1 medicines like semaglutide for obesity, we have heard much speculation about dire prospects for the future of metabolic surgery. Stock prices dropped earlier this year for medical device companies with big investments in bariatric surgery when Intuitive Surgical announced they were seeing a slowdown in this business segment.

But it seems this may have been an overreaction. In fact, some health insurers are seeing GLP-1 medicines as a reason to create incentives for metabolic surgery.

Improving Outlooks

Improving volumes in metabolic surgery procedures have surprised analysts in the last quarter of 2023.

Johnson & Johnson CEO Joaquin Duato is hearing from surgeons that rising adoption of medical strategies for obesity care may actually produce a rise in demand for metabolic surgery:

“When we talk to bariatric surgeons, many of them comment on the fact that they could see a tailwind for bariatric surgery down the road. Many of the patients –about 30% of them – are not going to be tolerating these medications. There would be another funnel for our bariatric business.”

Incentives for Health Insurers

Tufts professor James Chambers says that GLP-1 medicines may be prompting health insurers to re-think a restrictive mindset about metabolic surgery:

“This is an example of how a new technology is forcing the healthcare system to reevaluate existing technologies, not just in terms of the cost, but also the value.”

So Blue Cross Blue Shield of Michigan has removed prior authorization requirements for bariatric surgery. CMO Jim Grant explained:

“We saw, at the end of the day, that we were making people go through unnecessary hoops for bariatric surgery. Why make our physicians and our members go through unnecessary hassles?”

Likewise, Geisinger Health has expanded its coverage of metabolic surgery. Blue Cross Blue Shield in Vermont and Massachusetts have also updated their coverage requirements.

Data to Support Important Benefits

Meanwhile, data to describe important benefits from metabolic surgery continues to emerge. For example, recent data suggests that “bariatric surgery may mitigate the natural history of cognitive decline in individuals with obesity, which is expected to be faster than normal aging.”

Obesity Action Chair Kristal Hartman described the positive scenario she sees emerging for access to metabolic surgery:

“We already have data that shows the surgery has shown to be successful. Insurers may be thinking, ‘We should start reducing some of the barriers to bariatric surgery while we work out everyone in the world thinking that suddenly 40% of America is going to be put on a $1,300 a month GLP-1 drug.’”

We have funny and convoluted health insurance systems controlling how people can access important medical care for obesity. This might be a time when it moves in a positive direction.

Click here, here, and here for further perspective.

Carrot, photograph by Amada44, licensed under CC BY-SA 3.0

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January 17, 2024