Supplies of high-demand obesity treatments are improving, but that doesn’t mean they're easier to get. Many employers and health insurers are scaling back coverage of Wegovy or Zepbound and a key government program, Medicare, doesn’t cover the drugs for obesity. Clouding the picture even further, some big employers are adding coverage.
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Here are tips to seek a diagnosisApple drops encryption feature for UK users after government reportedly demanded backdoor accessHarissa brings complex chili heat to this meaty Libyan soup during RamadanPope is awake, resting on 10th day of hospitalization after early stages of kidney problem detectedLíderes extranjeros visitan Ucrania para expresar su apoyo en el tercer aniversario de la guerraLos conservadores ganan elecciones en Alemania, el ultraderechista AfD asciende al 2do lugarMany employers and insurers are scaling back coverage of Wegovy and Zepbound and a key government program, Medicare, doesn’t cover the drugsTreatment prices that can top hundreds of dollars monthly even after discounts make it hard for many people to afford these drugs on their own. That can make the life-changing weight loss that patients seek dependent on the coverage they have and how long it lasts. Coverage complications are not unusual in the U.S. health care system. But the challenge is magnified for these obesity treatments because a wide swath of the population“There are a lot of people right now who want access to the medication and can’t get it,” said Katherine Hempstead, a Robert Wood Johnson Foundation senior policy adviser.Paul Mack dropped about 70 pounds after he started taking Wegovy. The Redwood City, California, resident said food noise — constant thoughts of eating — faded, and he was able to have a heart procedure. The treatment was covered by California’s Medicaid program, Medi-Cal. Then the 50-year-old security guard got a raise. He no longer qualified for Medi-Cal and lost coverage of the drug for several months starting last summer.Coverage of these drugs remains patchy more than a year after Zepbound entered the market to challenge Wegovy. The benefits consultant Mercer says 44% of U.S. companies with 500 or more employees covered obesity drugs last year. It’s even more common with bigger employers. More than a dozen government-funded Medicaid programs for people with low incomes also cover obesity treatments. But few insurers cover the drugs on individual insurance marketplaces. And some plans restrict their coverage with things like requests for prior authorization or pre-approval. The lack of Medicare coverage remains a concern as well, especially for people who retire and move to the government-funded program from employer-sponsored coverage. “Patients come to us terrified about switching to Medicare and losing coverage,” said Dr. Katherine Saunders, an obesity expert at Weill Cornell Medicine and cofounder of the obesity treatment company FlyteHealth. “We start talking about backup plans a year before they transition.”Philadelphia-area insurer Independence Blue Cross dropped coverage of the drugs solely for weight loss for some customers starting this year. Company officials say the insurer worried about premium hikes it would have to impose on all customers if it continued. These concerns make Vanderbilt University researcher Stacie Dusetzina wonder how long employers who have added coverage will keep it, now that the drugs are “That’s probably going to spike spending,” said Dusetzina, a health policy professor who studies drug costs. Drugmakers tout the savings these drugs can provide by improving patient health and warding off future serious medical conditions like heart attacks or strokes. But health care experts note that there are no guarantees that the employer or insurer who covers the drug will eventually reap those benefits because people may change jobs or insurers.Leaders at Zepbound maker Eli Lilly have seen coverage grow steadily for their drug, and they’re optimistic that will continue.A bill calling for Medicare coverage has been floating around Congress for years. But it isn’t scheduled for a vote.Dr. Amy Rothberg says the lack of consistent coverage leaves her conflicted about writing prescriptions because she’s not sure how long patients will be able to take the drug., they regain their weight,” said Rothberg, director of the University of Michigan’s weight-management program. “I don’t want to do harm.” Some insurers require diet and exercise changes for the patient before they will cover a weight-loss medication. Those changes should happen in conjunction with starting the medicine, said Dr. Lydia Alexander, president of the Obesity Medicine Association. She’s also seen requirements for a body mass index of 40 or more, which equates to severe obesity, before coverage can start.____ The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.Murphy covers how people and businesses navigate the U.S. health care system. He is a member of AP’s Health and Science team.American Airlines flight from New York to New Delhi lands safely in Rome after security concernConservative opposition wins German election and the far right is 2nd with strongest postwar result
Medication Government Programs Robert Wood Donald Trump Joe Biden Obesity Health Care Costs Medicare Weight Management California North Carolina West Virginia Lydia Alexander Business Lifestyle Paul Mack Amy Rothberg Katherine Saunders Katherine Hempstead Health Stacie Dusetzina
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