Independence restricts health coverage for weight loss drugs

The list prices for these weight loss medications is an ongoing problem that needs to be addressed, said Dr. Kunal Shah, clinical director of obesity medicine at the Rutgers Center for Metabolic Health and Weight Management.

But he said there is potential for long-term savings if people can use these medications to better manage or prevent risks and complications related to obesity, including heart disease, diabetes, cancer, kidney disease, osteoarthritis, asthma and more.

Shah said there are some people who want these medications not because they are obese or overweight, but rather to become even thinner or reach a specific lower weight.

But broadly reducing access to these drugs through insurance restrictions and cuts will likely affect many more people whose weight is causing them health issues and affecting their quality of life, he said.

“I’ll have someone who has pre-diabetes, who has sleep apnea, who has COPD and they’re 300, 400 pounds. They’re on oxygen, they can barely get up out of their seat without getting short of breath,” Shah said. “Losing 30, 40, 50, 60 ,70, even 100 pounds would be life changing. They may be able to get off oxygen, they may be able to exercise more. And then I have to tell them, listen, your insurance is not going to cover it.”

Shah said this can be an especially frustrating situation for patients who are older and may not have the physical ability to exercise as much as they once did, so medication for weight loss could be an alternative option.

But Medicare, which is a federal insurance program for people 65 and older, does not cover these medications solely for weight management, only for diabetes and heart disease.

“Part of the difficulty with being a physician that treats medical obesity is having to come up with options that we know are not superior to what we want to give and having to give ‘inferior’ options because the limiting factor is insurance coverage,” Shah said.