Amid concerns about the cost of using glucagon-like peptide 1 agonists (GLP-1) to treat obesity, some insurers are imposing restrictions or eliminating coverage of these drugs. However, plans are maintaining access to bariatric surgery or making it easier to obtain. While GLP-1 drugs are effective in reducing weight and lowering the risk of cardiovascular events, their high prices are leading insurers to reconsider coverage.
Bariatric surgery is considered cost-effective, particularly for individuals with morbid obesity and type 2 diabetes. The procedure has been shown to reduce weight, metabolic comorbidities, and mortality compared to lifestyle interventions alone. Some insurers are now easing access to bariatric surgery, removing prior authorization requirements and expanding coverage. The cost of bariatric surgery ranges from $17,000 to $26,000, with insurers able to recover these costs within two to four years by reducing spending on obesity-related conditions.
Some insurers, such as the North Carolina State Health Plan, have stopped covering GLP-1 therapeutics for weight loss due to their high costs. While these drugs can be effective, they can cost up to $1,000 per patient per month. The state treasurer of North Carolina stated that expenditures on weight loss medications had increased significantly in recent years and accounted for a large portion of the plan’s pharmacy budget. The plan will continue to cover bariatric surgery for morbidly obese individuals who are indicated for the procedure.
Last year, the University of Texas health system, Ascension, and other large payers made similar decisions to stop reimbursing weight loss drugs. Medicare covers bariatric surgical procedures for patients who meet certain conditions related to morbid obesity but prohibits coverage of obesity drugs for weight loss alone. While some Medicare beneficiaries may have limited access to certain drugs, plans may be hesitant to pay for these high-cost medications.
Bariatric surgery has been shown to be more effective than drugs in reducing weight but carries a higher risk of complications. GLP-1 drugs offer a less invasive alternative with significant weight loss benefits and a lower risk of adverse events. Despite the shift in coverage policies, some patients may opt for surgery while others may go untreated pharmaceutically, potentially leading to long-term consequences for payers’ healthcare spending.
In conclusion, insurers are reevaluating coverage of obesity treatments, with some deciding to limit access to GLP-1 drugs while expanding coverage of bariatric surgery. While bariatric surgery is viewed as cost-effective and efficacious, the high cost of obesity medications is leading to coverage changes. Patients and healthcare providers will need to consider the implications of these changes on access to treatment options and long-term health outcomes.
