Are Health Plans Insuring Profits More Than Health?
“It’s absolutely insane to try to keep up with it all,” says obesity medicine physician Laura Davisson. She is talking about the impossible maze of requirements that so-called health insurance plans set up to prevent people from securing coverage for medicines to treat obesity. It leads us to ask: Are health plans insuring profits more than health?
Out of Balance
Our question is not rhetorical. It comes from observing how health plans systematically create an administrative burden that has the effect of denying people access to medicines for obesity.
Health plans must balance cost and health outcomes, says the industry’s trade group, AHIP. Of course, this is true. But it also seems true that they are failing at achieving the balance they claim to seek.
When it comes to obesity, the most apparent strategy is to minimize treatment. Keep people from starting therapy. Cause them to stop it if they start.
How else can we explain a Blue Cross Blue Shield plan that tries to charge a member a $700 “copay” for a month of an obesity medicine that’s readily available for a total cost of $500 monthly? Remember that a “copay” is a portion of the cost of a healthcare service paid by the patient in addition to what the insurance pays. But in this case, the insurance is paying nothing and someone is trying to make a windfall profit. So the patient walks away with untreated obesity.
This is how it unfolded for Kevin Sykes, as reported by the Washington Post. It is a scenario playing out repeatedly as health insurers cut back on the coverage of highly effective obesity medicines.
Using Patients as Pawns in Price Negotiation
If there is any good news in this situation, it is that net prices are coming down rapidly. Already, the cash price for Wegovy and Zepbound have dropped from $1,300 monthly to $500. We would expect that pharmacy benefit managers get an even sweeter deal. This might explain the recent announcement by Cigna that their pharmacy benefit plans will charge a copay that is never more than $200 per month.
We are headed to a better and more affordable situation. But along the way, both pharma and health insurers are using patients as pawns in price negotiations. This is wrong.
Untreated Obesity Destroys Health
Both parties in this price negotiation claim health as the core of the purpose for their business. But untreated obesity destroys health. And by protecting profits more than health, both pharma and health insurers are losing sight of their purpose.
Click here for free access to the Washington Post article describing the “insane” maze that health insurers have created to keep people from getting obesity care.
Mammon, painting by George Frederic Watts / Wikipedia
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May 27, 2025