The Tide of Obesity Medicines Rolling into Health Plans

It’s quite weird, actually, watching the contortions of health plans as they twist to resist the rising tide of obesity medicines. Because despite the twisting and contortions, obesity medicines are as difficult to resist as a rising tide. Those who pretend it is not happening find themselves under water.

A new survey from the International Federation of Employee Benefit Plans gives us a rather clear reading on this rising tide of obesity medicines in U.S. health plans. Last year, 49% of plans covered GLP-1 medicines, but only for diabetes. This year that number is up to 57%. Another 26% covered them for both diabetes and obesity last year. That number rose to 34% this year. Only five percent of plans completely exclude them now. Last year, the number was 17%.

Yes indeed. These drugs – which represent a breakthrough in medical care for obesity, diabetes, and a range of problems that result without treatment – are rolling into health plans.

Weirdness and Stupidity

Change is scary. This is the only way we can explain the twisted weirdness of behavior from health plans as they try to resist this rising tide. Healthcare providers deal with a daily onslaught of this as they deal with prior authorization hurdles that tend toward bizarre.

For a glimpse of this absurdity, consider the case of an adolescent we’ll call Martin. He is a 16-year-old with severe obesity who is responding quite well to semaglutide. After a year of therapy, his body mass index has dropped below 26. This is an outcome that was hard for him to imagine a year ago. His life and his health are clearly better because of it. So naturally, his health insurance company instructs his physician to discontinue the drug. That’s the nonsense that popped up this week on the screen of a doctor who shared it with us.

Anyone who knows anything about obesity knows that discontinuing therapy in this case makes no sense. The patient will most likely regain all the weight he lost and then some. His health will suffer – along with his outlook on life. This decision is every bit as ridiculous as telling a doctor to discontinue a medicine that’s working to control high blood pressure. In both cases, the discontinuation will harm a person’s health.

Growing Understanding, Growing Coverage

But the reason the tide is rising is that ignorance doesn’t last forever. We are seeing the general knowledge about obesity rise with the tide of better options for treating it. Research by Caroline Ben Nathan and colleagues tells us that when benefit managers understand the biological basis for obesity, their support for covering obesity treatment grows.

Health plans that deny access to effective obesity medicines are failing in their fundamental mission – to support good health for the people enrolled in their plan. Untreated obesity causes so many other health problems that denying coverage is a moral failure that will inevitably harm the business reputation of any health plan that persists with this outdated behavior.

As the tides of better obesity treatment roll in, health plans that keep resisting will be engulfed by the tide and washed out to sea.

Click here for the survey of U.S. health benefit plans, here, here, and here for more about it. For the research by Nathan et al, click here.

Rising Tide, St. Malo, painting by Maurice Prendergast / WikiArt

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June 20, 2024