Outlook Changing in Payer Coverage for Obesity Medications, Commentators Say

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Many hoped the 2013 declaration by the American Medical Association that obesity is a disease would open the door for payer coverage of pharmacotherapy to treat it. While that did not happen right way, a new commentary in Evidence-Based Diabetes Management by Ted Kyle, RPh, MBA, and Fatima Cody Stanford, MD, MPH, MPA, outlines how the tide appears to be turning for coverage of evidence-based treatment.

Evidence-Based Diabetes Management is a publication of The American Journal of Managed Care.

For too many patients, obesity drugs have been unaffordable, which has limited treatment options.

At long last, payer coverage for obesity pharmacotherapy appears to be gaining traction, giving physicians and their patients important evidence-based tools to treat obesity, according to a new commentary in Evidence-Based Diabetes Management, a publication of The American Journal of Managed Care.

Co-authors Ted Kyle, RPh, MBA, chairman of the Obesity Action Coalition, and Fatima Cody Stanford, MD, MPH, MPA, a physician in the Massachusetts General Hospital Weight Center and an instructor at Harvard Medical School, discuss how coverage for obesity drugs has varied since the American Medical Association (AMA) declared obesity a disease in their commentary, “Stumbling Toward Access to Evidence-Based Care for the Chronic Disease of Obesity.” While many hoped the AMA declaration in June 2013 would open doors for payer coverage, the authors explain how things have unfolded more slowly, despite the evidence. For the commentary,click here.

Under the Affordable Care Act, they write, “while 23 states classify bariatric surgery as an essential health benefit, only 5 states classify medical obesity treatment as an essential benefit.” The result is that for too many patients, obesity drugs have been unaffordable, limiting treatment options. However, as Kyle and Stanford write, the past year has brought several key shifts:

  •     In 2014, the AMA resolved to press for patient access to a full spectrum of options, including obesity drugs.
  •     Also in 2014, rules for federal employee health plans changed to require coverage of obesity therapies.
  •     The National Conference of Insurance Legislators called on state legislatures to cover “the full range of obesity treatment,” and major pharmacy benefit managers are starting to add drugs to the formulary.
  •     Bipartisan support is building to add obesity drugs to Medicare Part D.

About the Journals and AJMC.com

The American Journal of Managed Care celebrates its 20th year in 2015 as the leading peer-reviewed journal dedicated to issues in managed care. AJMC.com distributes healthcare news to leading stakeholders across a variety of platforms. Other titles in the franchise include The American Journal of Pharmacy Benefits, which provides pharmacy and formulary decision-makers with information to improve the efficiency and health outcomes in managing pharmaceutical care, and The American Journal of Accountable Care, which publishes research and commentary on innovative healthcare delivery models facilitated by the 2010 Affordable Care Act. AJMC’s Evidence-Based series brings together stakeholder views from payers, providers, policy makers, and pharmaceutical leaders in oncology and diabetes management. To order reprints of articles appearing in AJMC publications, please call (609) 716-7777, x 131.

Nicole Beagin
(609) 716-7777 x 131

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Nicole Beagin
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