The U.S. Food and Drug Administration (FDA) has approved a total of four prescription drugs for obesity since 2012. In a population where two-thirds of the adults are considered overweight or obese, it is not surprising that there is such a demand for the medications. The most recent drug to gain FDA approval is called Saxenda. The drug was approved in December, 2014, and insurance companies have already stated that they will not cover it.
A cautious approach to weight loss drugs may be prudent. There has been a history of past weight-loss medications leading to serious, adverse consequences. For example, in 1997 fenfluramine was withdrawn from the U.S. Market after it was found to damage heart valves. Fenfluramine was one part of the fen-phen diet drug combination that lead to numerous lawsuits and a multi-billion dollar settlement.
It is estimated one third of insurances companies with not cover any obesity drugs. Another third are predicted to cover only FDA-approved weight-loss drugs. The final third will support some FDA-approved treatments but place heavy restrictions on how they are used. Medicare explicitly states that it will not provide coverage for prescription obesity drugs.
Drugs for obesity are seen as long term investments. Losing weight may not have immediate effects, but it can improve blood sugar, cardiovascular health, and decrease a multitude of risk factors for other complications over time. Plan sponsors, however, may have employees that won’t be around long enough for the employer to benefit from these long-term health improvements. Employers may be focused on health insurance that supports treatments that have more immediate effects.
Patients and their physicians should be the forefront of any healthcare decision. Unfortunately, this is not always the case. When an insurance company’s priorities and patient priorities diverge, the patient may pay a price. Appealing a health insurance denial can be difficult and time-consuming. Contact the attorneys of Lopez McHugh, LLP to discuss your legal options if you’ve been denied necessary medical treatment.