Ricky MondelloI’m curious — does your employer’s health insurance cover weight loss medications?
Sunil@rmondello Nope. Only benefit from employer insurance is dental and once in couple of years for partial cost of prescription glasses. That’s Canada.
Aleen@rmondello we have really stellar insurance through Justin's employer. They don't cover GLP-1 agonists if the patient doesn't have diabetes. I don't know about other classes of weight loss meds.
Greg Pierce@aleen @rmondello I don't think you'll find any insurance that covers off-label use of most any drug. Until the FDA approves the GLP-1 agonists *for weight loss*, I don't seem them covering it.
@agiletortoise @rmondello According to my last couple of PCPs, there are carriers who will cover them, but it's definitely the exception.
I also have to acknowledge that doctors are usually fairly far removed from insurance coverage questions.
Kyle Hughes@agiletortoise @aleen @rmondello This is the correct answer. GLP-1 inhibitors are not weight loss drugs by any technical definition yet. Additionally, they seem to require prior authorization which means your doctor has to apply for you, and that means insurance is keeping a keen eye.
You can find out all specific coverage information, including what therapies are approved and what the requirements are, by searching “<insurer> formulary”.
e.g. here is mine https://blueshieldca.adaptiverx.com/webSearch/index?key=8F02B26A288102C27BAC82D14C006C6FC54D480F80409B68651080F44A11E57C
Michael Fessler@agiletortoise @aleen @rmondello Wegovy is the same drug as Ozempic (semaglutide), but specifically approved for weight loss. Same for Zepbound and Mounjaro (tirzapatide).
@mfessler @aleen @rmondello Not pretending to be an expert, so perhaps that has changed. I thought that was qualified with a requirement of a coincident diagnosis of other weight-related conditions, like diabetes.
@LOL! Self employed in the US which means I pay through the nose for crappy healthcare to the point I can’t afford extra food to need to lose weight from.
starling@rmondello kind of. there are lots of qualifications and you have to get prior authorization etc. currently dealing with that madness.
Corry Haines@rmondello no, though incredibly the US federal employee insurance not only does, but makes an impassioned case in the medication’s favor
@corry This bit about the US federal employee insurance sounds like something you’re decently knowledgeable about. Is this something you could tell me more about or send resources you recommend about?
@rmondello I have a little snippet I put together recently in another context, quotes are from the OPM website or carrier letters:
> in 2014, OPM issued Carrier Letter 2014-04 clarifying that it is not permissible to exclude weight loss drugs from FEHB coverage on the basis that obesity is a “lifestyle” condition and not a medical one or that obesity treatment is “cosmetic.”
> In Carrier Letter 2022-03, OPM stated that FEHB Carriers are not allowed to exclude anti-obesity medications from coverage based on a benefit exclusion or a carve out. Carrier Letter 2022-02 outlines the requirements for NonDiscriminatory Formulary Design, namely, that a non-discriminatory formulary design does not have cost or access barriers imposed by disease or condition.
> As new anti-obesity drugs are approved by the FDA, OPM expects Carriers to evaluate and update their coverage of anti-obesity drugs.
The "letters" being referenced are available on the OPM website: https://www.opm.gov/healthcare-insurance/carriers/fehb
AFAIK these letters were issued as a result of union action, but I haven't confirmed that.
Chiasm@rmondello Doubt it, at least not without a time-consuming war of attrition about it.
Michael@rmondello yea but the dr had to fight for it. (Not related to diabetes)
Christopher Garcia@rmondello they covered my wife’s briefly then revoked it
Dan V Peterson@rmondello Sadly no, only if you’re diabetic
Arthur Rosa@rmondello yes, but only if you prove that starving yourself for 6 months first doesn’t work.
DrYak@rmondello As a reference, in Switzerland, it can be reimbursed by standard insurance, after a special request by the endocrinologist and as long as it is part of a protocol combining other approaches too (diet, exercise, etc.) in patients whose BMI is "obese" or is "overweight" + diabetes / hypertension /etc.