AMA Urges Full Coverage of Obesity Treatments by Insurance Companies and Federal Payers

Published on November 15, 2023, 12:47 am

The American Medical Association (AMA) is pushing for insurance companies and federal payers to fully cover a new class of obesity treatments, such as Wegovy and Ozempic. In a recent vote, the AMA passed a resolution advocating for “health insurance coverage parity for evidence-based treatment of obesity, including FDA-approved medications without exclusions or additional carve-outs.”

The AMA considers obesity to be a disease that poses significant health risks if left untreated. It believes that providing comprehensive coverage for obesity treatments is crucial in addressing this pressing health concern. By supporting the coverage of FDA-approved medications for weight loss without any restrictions, the AMA aims to put pressure on insurers and the federal government to take action.

Currently, federal law prohibits Medicare from covering weight-loss drugs. However, Congress is contemplating potential policy changes in this regard. Private insurers have also been reluctant to cover these drugs, often categorizing them as lifestyle or cosmetic medicine rather than essential treatments.

While diabetes medications like Ozempic and Mounjaro have been used off-label for weight loss, there is now an officially approved class of medicines called GLP-1 treatments designed specifically for obesity. Drugs like Wegovy and Zepbound are part of this new class and have received approval from the Food and Drug Administration (FDA). These medications have shown promise in helping patients lose a significant amount of weight; however, they come with a high price tag exceeding $1,000 per month.

Given that nearly half of the country’s population is considered overweight or obese, there is a growing need for effective obesity treatments. However, many insurers have implemented policies such as lifetime coverage caps, burdensome paperwork requirements, or outright refusal to cover FDA-approved weight-loss drugs.

The AMA acknowledges that the costs associated with obesity can be substantial both for patients and the broader healthcare system. Therefore, it emphasizes the urgency of addressing this disease comprehensively through various suitable treatments.

This call by the nation’s top physician lobby adds weight to the ongoing dialogue surrounding obesity treatment coverage. It remains to be seen how insurers and the federal government will respond, but the AMA’s resolution serves as an important step towards achieving health insurance coverage parity for evidence-based obesity treatments.

(Note: This article contains information from an original source, but has been rewritten to adhere to the given guidelines.)