Mar 4, 2024 - Health

Weight-loss drug restrictions shine spotlight on imbalance in obesity care

Animated illustration of an equals sign morphing into a health plus.

Illustration: Aïda Amer/Axios

Tightening restrictions on who can receive the remarkably effective class of new weight-loss drugs is putting a spotlight on an imbalance in how health plans cover obesity care.

Why it matters: The explosive growth of Ozempic and other drugs known as GLP-1 agonists has led to greater recognition of obesity as a chronic condition rather than a lifestyle disease. But it's also sparked major concerns about the potential budget-busting costs of treating the more than 40% of Americans who are obese.

The big picture: While many employers offer some coverage for obesity care, it's typically far more limited and comes with more restrictions around what they will pay for compared with other conditions.

  • The divide is especially stark with anti-obesity medications. 76% of employers report covering GLP-1s for diabetes, but only 27% do for weight loss, according to a 2023 survey by the International Foundation of Employee Benefit Plans.
  • Medicare has long had a prohibition on covering weight-loss drugs, and some states are clamping down on them.

Driving the news: A group of health care organizations led by the Alliance for Women's Health and Prevention last month launched the EveryBODY campaign pushing for comprehensive coverage of obesity care, citing "misunderstandings" about obesity that it says led to insurance restrictions.

  • It came on the heels of the January release of an "Obesity Bill of Rights" by the National Council on Aging and National Consumers League, which calls out the medical system's disrespectful treatment of patients with obesity.
  • "Obesity should be treated like any other serious chronic disease," said Tracy Zvenyach, policy director at the Obesity Action Coalition.
  • It's worth noting drugmakers, who'd benefit from more customers, are fueling some of this debate. For instance, Eli Lilly, which makes Mounjaro for diabetes and Zepbound for obesity, is a backer of the EveryBODY covered campaign.

What they're saying: Disparities in coverage for obesity likely reflect pervasive societal biases, said Zeke Emanuel, a medical ethicist and former Obama health policy adviser.

  • Emanuel co-wrote a Wall Street Journal opinion piece last week condemning North Carolina's decision to stop covering GLP-1s as weight loss treatments for the more than 700,000 people enrolled in the state health plan.
  • "What was said for North Carolina was 'There's a whole swath of people, we're not covering it for them because they're obese.' That is unethical," Emanuel told Axios.
  • While Emanuel said he recognizes the drugs' high price tags are a challenge, he argues they look much more cost-effective when you consider their potential to prevent severe health problems associated with obesity.

The other side: Employers are beginning to recognize the value their workforces could get from comprehensive obesity care, said Shawn Gremminger of the National Alliance of Healthcare Purchaser Coalitions, which represents coalitions of employers purchasing health care.

  • A 2023 survey by Accolade found that while roughly 1 in 4 of HR managers said their companies offered GLP-1s, nearly 80% said covering the drugs would help employees' health long-term and would enhance their benefits packages.
  • However, Gremminger said employers are still weighing emerging research about the new weight-loss drugs and questions about what types of treatment are most effective for particular patients.
  • Decisions to more broadly cover weight-loss drugs could mean potentially millions of dollars in new health care costs for larger companies, which could result in cuts elsewhere, he said. It could also run afoul of laws that require them to be good stewards of their benefits, he said.

The bottom line: With more drugs expected to hit the market, and the likelihood that they'll be approved for other conditions like cardiovascular disease, pressure will keep growing on employers to cover GLP-1s and other obesity care.

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