AMA Urges Coverage Of Obesity Treatments As Payers Balk At Costs

The American Medical Association called on insurance companies, employers, and government programs to cover obesity treatments even as many remain reluctant to pay for them, fearing the costs of covering the drugs at a mass scale.

The large physicians’ lobbying group voted to pass a resolution at the association’s interim meeting Monday saying it will “urge all payers to ensure coverage parity for evidence-based treatment of obesity, including FDA- approved medications without exclusions or additional carve-outs.”

Medicare is prohibited by law from covering weight loss treatments, and commercial coverage has historically been spotty, with many insurers viewing them as cosmetic rather than medical treatments. More recently, the emergence of GLP-1-based treatments like Novo Nordisk’s Wegovy and Eli Lilly’s Zepbound have raised concerns about cost. While the new drugs cause significant weight loss, they carry list prices of over $12,000 annually and are meant to be taken indefinitely. In addition, a vast number of people — almost half the U.S. population — are eligible for the medications.

Insurers have responded by instituting strict requirements for coverage, and some employers have even decided to completely stop covering obesity drugs.

But doctors say these actions are creating a patchwork of restrictions that are barring access for patients who need the medications to not only lose weight, but also address related health problems. Doctors point to data that’s been recently released showing that Wegovy offers cardiovascular benefits in addition to weight loss.

The resolution by the AMA, one of the most influential medical groups in the U.S., adds further pressure on insurers. The association has increasingly taken stances pushing for changes in the way the health care community views obesity. Just a few months ago, it passed a policy asking doctors to de-emphasize the use of the body mass index to assess obesity and people’s health.

“We have good drugs on the market. Patients deserve them. But today only rich people can get them,” Ethan Lazarus, past president of the Obesity Medicine Association, said in support of the resolution at the meeting. Lazarus also does speaking events for Novo.

The AMA 10 years ago ratified a resolution officially calling obesity a disease. “We’ve come a long way in that timeframe, but we haven’t come a long way in getting patients the medications that they desperately need,” Jonathan Leffert, a delegate of the American Association of Clinical Endocrinology and one of the authors of the 2013 resolution, said at the meeting.

However, not all the doctors in attendance supported the resolution during discussions.

Vanita Rahman, a clinic director at Barnard Medical Center in Washington, D.C., said rising obesity rates over the past decades are largely related to the increase in processed foods and other environmental factors. The drugs are effective at helping people lose weight, but they’re costly and people must remain on them indefinitely to maintain weight loss, she noted.

“Rather than advocating for expensive drugs with limited and short-term benefits only, investing the same resources on diet and lifestyle could help far more Americans stay healthy for life,” Rahman said.

Neal Barnard, an adjunct associate professor at the George Washington University School of Medicine, said he doesn’t think insurers should be required to cover obesity treatments. If commercial plans or Medicare pays for them, that could ultimately lead to higher costs to all insured people, such as through higher plan premiums or higher taxes, he said.

The new drugs’ economic effects on the health system are under debate. Novo and Lilly have shown numerous studies conveying the message that their treatments would prevent people from developing complications like diabetes and heart disease and save costs in the long run. Independent researchers, however, have conducted analyses concluding that the drugs aren’t cost-effective, even at deep discounts.

The Institute for Clinical and Economic Review, a nonprofit organization that evaluates the cost-effectiveness of drugs, found that covering Wegovy at its current price for just 0.1% of the eligible population would probably force insurers to shift money or increase premiums.

Makers of the GLP-1 drugs have spent considerable resources encouraging doctors to understand obesity as a disease. On Saturday, Carolynn Francavilla, a family physician from Green Mountain Partners for Health in Lakewood, Colo. who has investments in and has given talks sponsored by Lilly, said: “We need it all covered so we can provide this care for our patients. We called it a disease more than 10 years ago. Let’s treat it.”

On Monday, the resolution passed without further discussion.


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