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The politics behind insurance companies covering weight-loss drugs

Out-of-pocket costs for some prescription weight-loss drugs can hover around $1,000 per month for some individuals.
The politics behind insurance companies covering weight-loss drugs
Posted at 2:50 PM, Apr 04, 2024

Everyone wants to step on the scale and feel good, but that isn't always how most Americans feel. In fact, the Centers for Disease Control and Prevention reports that 4 in 10 Americans are struggling with obesity.

That is where drugs like Ozempic and Wegovy may help. They have shown to help with weight loss, while reducing the risk of heart attacks and strokes in adults who are overweight. 

There is only one problem: Changing the numbers on the scale with the help of a prescription drug remains too costly for many Americans.

"The real problem in America is that obesity as a disease state is not a standard benefit on insurance. It should be a standard benefit like other diseases," said Dr. Angela Fitch, the president of the Obesity Medicine Association.

She says the problem that's preventing more Americans from accessing the drugs is cost and uncharted territory for insurance companies.

SEE MORE: Costco now offers weight-loss program that includes Ozempic and Wegovy

Right now, out-of-pocket costs for Wegovy average more than $1,000 a month. 

Fitch faults an outdated law for the reason why the weight-loss drugs are so expensive. 

"We carved it out years ago because it was considered aesthetic. So, we carved it out many years ago, out of insurance, because it was considered cosmetic. And we know now it's not cosmetic, so we shouldn't carve it out anymore," she said. 

Fitch believes Congress should step in. She wants to start with Medicare.

The Treat and Reduce Obesity Act would allow Medicare to cover weight loss drugs. If Medicare covers it, the thinking is many private insurance companies would follow suit.

Medicare recently announced that weight loss drugs would soon be covered for those with Part D coverage, but the patient must demonstrate a heart-related illness. 

Fitch believes it should be covered before an overweight American has a heart attack or receives a heart disease diagnosis.

"It's our biggest public health crisis of today," she noted.

That legislation faces an uphill battle in Congress. The outcome of this year's election could be critical, and other weight-loss fights appear to be brewing.

Sen. Bernie Sanders last week released a statement calling on drug companies to reduce the price of weight loss drugs after it was reported in one study that some weight loss drugs could be produced for less than $5 a month.

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