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April 16, 2014
Coverage for Obesity Drugs Required in Federal Worker
Health Plans

Washington, D.C.—Health insurance plans serving about 2.7 million federal employees now will be required to cover medications for obesity, according to a recent letter from a federal regulator.

“It has come to our attention that many [federal health insurance] carriers exclude coverage of weight-loss medications. Accordingly, we want to clarify that excluding weight loss drugs from [such] coverage on the basis that obesity is a ‘lifestyle’ condition and not a medical one or that obesity treatment is ‘cosmetic’ is not permissible,” writes John O'Brien, director of healthcare and insurance at the Office of Personnel Management.

In a blog post, the executive director of The Obesity Society, Francesca Dea, suggests that other private health plans, which often do not cover drug therapy for obesity, should fall in line with those standards.

“We call on all public and private health plans to follow suit and embrace coverage of evidence-based obesity treatment avenues, such as intensive behavioral therapy, pharmacotherapy and bariatric surgery so that those affected can access to the full continuum of care for this complex and chronic disease,” Dea writes.

The dictate from the federal government applies to a range of obesity treatments, including new drugs such as Qsymia and Belviq.

In the letter, O’Brien urges health plans to use “stringent utilization management protocols, including prior approval, duration of therapy limits, and medical necessity review” to mitigate any potential problems with central nervous system stimulants, which sometimes are abused and misused.

Late last year, the National Heart, Lung, and Blood Institute (NHLBI) guidelines on the management of overweight and obesity were issued for the first time in 15 years.

The guidelines recommend pharmacotherapy for patients unable to achieve and sustain weight loss with comprehensive lifestyle interventions alone. The document suggests that prescribers initially try the drugs for 12 weeks in patients with body mass index (BMI) greater than 30 or 27 with comorbidities. If patients are losing weight, the guidelines recommend continuation of therapy.




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