With the new year upon us, many people are focused on weight loss and weight management. This is an apt resolution for many, as the Centers for Disease Control and Prevention found obesity rates are over 39% in each adult age group. Understandably, many insurers are striving to expand covered services for weight loss due to their role in preventing many chronic health conditions such as cancer, hypertension, and diabetes.
Weight loss drug coverage
Reimbursement for drugs such as GLP-1 agonists varies between carriers, especially when these medications are prescribed solely for weight loss. A recent poll showed that just 1 in 4 people taking these medications had coverage from their insurance provider for this prescription.
Some insurers are hoping to make coverage for non-pharmacological weight loss services more robust to bridge this gap and support members in this area. However, this has presented challenges for some insurers.
Gaps in provider knowledge
In the last few years, people have had more access to weight loss medications than ever before. However, over 50% of primary care providers lack sufficient education in this specialty area. Many physicians are also not comfortable addressing issues such as weight management with patients in need of this counseling. This impacts the quality of recommendations patients are given, which can lead to poorer outcomes and higher service utilization for preventable health concerns.
Patient safety
This class of medication isn’t for everyone. Some patients with certain preexisting conditions, such as diabetes, are at risk of serious side effects, and those who stop taking these medications often regain their weight. In addition, misuse of GLP-1 agonists can potentially lead to serious health concerns such as gallstones, pancreatitis, acute kidney injuries, and medullary thyroid cancer. Surgical patients taking GLP-1 agonists may also experience complications, as these medications can lead to a higher risk of aspiration when under anesthesia and cause complications for patients preparing for a colonoscopy.
What can insurers do?
While initial costs are high, early research shows that GLP-1 agonists can be an economical long-term option to help curtail obesity-related complications. However, side effects and complications may make it unsafe for medically complex patients. More widespread reimbursement for these drugs may cause premiums to surge, so insurers may want to make coverage determinations on a case-by-case basis with a particular focus on patients who have diabetes.
Regardless, there are several ways insurers can effectively address weight management for their members:
- Search for additional health care clinicians who have proven expertise and a strong track record in weight management. Bariatric surgeons and physicians should be supplemented with other members of the interdisciplinary team, including registered dietitians, licensed mental health counselors, behavioral therapists, certified health coaches, and exercise physiologists.
- Boost screening efforts for patients with obesity and chronic conditions such as diabetes. This will ensure the best outcomes for those prescribed GLP-1 agonists for preventive purposes.
- Bolster provider networks with clinicians who understand the importance of health outcomes such as weight loss, increased muscle mass, endurance, and cardiovascular metrics.
- Leverage digital health, telehealth, wearable trackers, and other forms of technology to assist with measurable progress reporting.
- Offer continuing education opportunities for primary care providers and generalists in the area of weight management.