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Aetna to Begin Covering Cost of Weight Management Medications in Certain Patients

Published: 11/29/12
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The past few months have seen the approval of a pair of new drugs designed to treat obesity, Arena’s Belviq (see new now next in diaTribe #44) and Vivus’ Qsymia (see new now next in diaTribe #45). While Belviq is slated to launch in early 2013, Qsymia launched this past September (see new now next in diaTribe #47), and monthly costs for Qsymia range from $120 to $184, depending on the dose. Because Medicare and more than two-thirds of private insurers are not currently covering weight-management medications, the expectation is that most potential users of Qsymia – and eventually Belviq – will need to pay out of pocket.

Some potentially good news on that front came on November 21, as Aetna announced that it would begin covering weight management drugs in certain patients. This announcement does come with several important caveats, not least of which is that many Aetna plans specifically exclude any obesity medications, and so neither Qsymia nor Belviq would be covered on those plans. However, Aetna members whose plans do allow for weight-loss drugs will be able to get coverage for either Qsymia or Belviq if (1) their BMI is greater than 30 kg/m2 or greater than 27 kg/m2 with one of five risk factors (coronary heart disease, high cholesterol, hypertension, sleep apnea, and type 2 diabetes); and (2) if they have failed to lose at least a pound per week after six months on a weight loss regimen. We think both points will be true for lots of patients and would encourage readers who would like to lose weight to look into it by calling their health insurance plans to inquire what their coverage is for obesity treatments. Specifically, those interested in the Aetna’s update can read it here.

We see this move as a step in the right direction for insurance coverage of Qsymia (and eventually Belviq), and we expect more payers will eventually follow suit. This particular announcement only moderately expands insurance coverage for the drugs, as Aetna has about 6% of Americans on its medical plans, and only an unknown number are eligible for obesity medication coverage. Nevertheless, any increased coverage really has to be considered good news, especially since Vivus has reported that around 30% of pending prescriptions have been abandoned by patients due to cost. We understand this too – losing weight shouldn’t cost patients so much who are trying to improve their metabolic health. Last, given how tough it is for most individuals to lose weight and/or maintain weight loss over the long-term, we hope insurers will view more frequent and continuous support (either in-person or virtual) as essential components to a successful weight loss program. –AW 

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