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Why Coverage Of Anti-Obesity Medications For Federal Employees Is Only Fair


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One of the rather explicit biases that has hindered greater investment into finding more effective obesity medications, has been the unwillingness of many health care plans to cover the cost of such medications for their members.

Indeed, many private and public health plans around the world explicitly exclude obesity medications (and other obesity treatments) from coverage.

This is clearly a double standard, given that the very same plans have no problem covering medications for other “lifestyle” diseases such as type 2 diabetes, hypertension, or high-cholesterol.

Now, in a rather dramatic move last month, the US Office of Personnel Management (OPM), responsible for health insurance coverage for  over 2.7 million Federal Employees, ruled in support of health coverage for FDA-approved weight-loss treatments stating that obesity exclusions are no longer permissible in health plans for federal employees.

This move should set an important precedent for other health plans to follow.

In the March 20th letter to all FEHB carriers, John O’Brien, the Director of Healthcare and Insurance at OPM, agrees that while

“diet and exercise are the preferred methods for losing weight, …drug therapy can assist [those] who do not achieve weight loss through diet and exercise alone.”

In the letter, O’Brien provides further clarification:

“It has come to our attention that many FEHB carriers exclude coverage of weight-loss medications. Accordingly, we want to clarify that excluding weight loss drugs from FEHB coverage on the basis that obesity is a “lifestyle” condition and not a medical one or that obesity treatment is “cosmetic”- is not permissible. In addition, there is no prohibition for carriers to extend coverage to this class of prescription drugs, provided that appropriate safeguards are implemented concurrently to ensure safe and effective use.”

This ruling should end the long-standing practice of discrimination against people with obesity who require and are willing to take medications for their condition.

Obviously, medications for obesity need to always be used as an “adjunct” to diet and exercise, in the same manner that medications for diabetes, hypertension or high-cholesterol should always be used as an adjunct to diet and exercise.

It goes without stating that prescription medications for obesity, diabetes, hypertension or high-cholesterol should only be made available to those who fail to control their weight, blood sugar, blood pressure, or cholesterol levels with diet and exercise alone. (there is no “special case” for the role of diet and exercise in obesity management that does not also apply to these other conditions).

And of course, as for any prescription drug, means and measures must be in place to avoid misuse and monitor safety of such treatments.

That said, recognizing that prescription obesity drugs, deemed both effective and safe by the FDA should be made available to patients in the same manner as drugs for other chronic conditions, is only fair to patients and represents a major step towards decreasing bias and discrimination against those suffering the health consequences of excess weight.

@DrSharma
Edmonton, AB

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3 Comments

  1. A few questions:

    1. Do you think that the cost of weight loss drug for people who are EOSS 0 or 1 is advisable? It seems to me that in their case, it IS a cosmetic issue.
    2. Don’t you think there should be some kind of cost-benefit analysis? For example, if a drug taken regularly for five years results, on average, in a five pound weight loss, is that really worth it?
    3. What if the drug has risks or side effects? Are you going to advise covering a weight loss drug for someone with a BMI of 32 and no other risk factors when it has potentially dangerous side effects?

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    • Medical decision should always be beased on a risk/benefit analysis – the lower the risk of the condition the less risk is justfiable. You only treat a condition when the risk of not treating is greater than the risk of treating.

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