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Amid increased concern about the costs of using glucagon-like peptide 1 agonists to treat obesity, some insurers are imposing further restrictions or eliminating coverage of the drugs altogether.
The cost of bariatric surgery ranges between approximately $17,000 and $26,000. It is estimated that insurers can recover those costs rather quickly, within two to four years, as spending on obesity-related conditions is eliminated.are now easing access to bariatric surgery. For example, Blue Cross Blue Shield of Michigan removed prior authorization requirements in September of last year. BCBS carriers in Massachusetts and Vermont have since updated their protocols as well.
The state treasurer, Dale Folwell, stated that the move to exclude coverage of prescription drugs was driven by their high prices. He acknowledged their effectiveness, but said that expenditures on weight loss medications had ballooned in recent years and accounted for up to 10% of the plan’s pharmacy budget, with 25,000 people taking the drugs in early 2024.
However, Medicare still prohibits coverage of all obesity drugs if prescribed as weight loss medications alone. The therapeutic Wegovy secured a supplemental cardiovascular indication from the Food and Drug Administration last month. This allowsfor certain Medicare beneficiaries who fulfill weight and major cardiovascular risk criteria. But it doesn’t follow that plans will necessarily jump to pay for the product, given the, yet it also carries a higher chance of complications.
As a consequence of a policy shift in which some plans decide to facilitate access to bariatric surgery while removing coverage of obesity medications, a still small number of patients may opt for surgery but a much larger group won’t be treated, at least not pharmaceutically. Though this may save payers money in the short run, if these patients remain overweight or obese there could be attendant consequences for payers’ long-term healthcare spending.
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Insurers Ease Access to Bariatric Surgery Amid Concerns Over Cost of Obesity DrugsSome insurers are making access to bariatric surgery easier amid concerns over the potential long-term costs of using obesity drugs. The American Society for Metabolic and Bariatric Surgery (ASMBS) states that the average cost of bariatric surgery ranges between $17,000 and $26,000, while the list price of obesity drugs like Wegovy is about $1350 for a 28-day supply. Insurers argue that the surgery is more cost-effective in the long run due to the reduction or elimination of obesity-related conditions and associated treatment costs.
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