Independence Blue Cross, the largest health insurer in southeastern Pennsylvania, will restrict coverage for weight loss medications, citing “exorbitant costs.” The decision affects people with IBX health plans and limits coverage to conditions approved by the Food and Drug Administration, such as Type 2 diabetes and cardiovascular disease.
The move follows similar restrictions from other major insurance companies and large employers. These restrictions may impact thousands of people who rely on these medications to manage their weight and reduce health risks associated with obesity.
Dr. Kunal Shah, clinical director of obesity medicine at the Rutgers Center for Metabolic Health and Weight Management, warns that reducing access to weight loss medications through insurance restrictions will affect many people whose weight is causing them health issues.
“These exorbitant costs have made it extremely challenging to be able to continue to provide drug coverage to everyone who wants these drugs but does not have an FDA-approved medical or indication for these drugs,” IBX stated. The company believes that this decision will lead to increased premiums for everyone else.
Shah emphasizes the importance of long-term savings from using weight loss medications to better manage or prevent risks and complications related to obesity, including heart disease, diabetes, cancer, kidney disease, osteoarthritis, asthma, and more.
While there are alternative options available, such as nutrition and behavioral health counseling, bariatric surgery, and different types of medications, Shah believes that weight loss medications can be a life-changing option for people with severe obesity.
Ahead of the changes in 2025, patients should prepare by asking their healthcare providers for a three-month refill now, in case they need to pivot. It’s essential for people newly considering weight loss medications to get evaluated by health providers who specialize in obesity medicine to increase the chances of insurance coverage.
Source: https://whyy.org/articles/independence-blue-cross-restrict-coverage-ozempic-weight-loss