Greater Philly’s largest health insurer restricts coverage for weight loss medications, citing ‘exorbitant costs.’

According to Dr. Kunal Shah, clinical director of obesity medicine at the Rutgers Center for Metabolic Health and Weight Management, the continuous issue that needs attention is the list prices for weight loss medications.

There is potential for long-term savings if individuals can utilize these medications to effectively manage or prevent risks and complications associated with obesity. This includes conditions such as heart disease, diabetes, cancer, kidney disease, osteoarthritis, asthma, and more.

According to Shah, some individuals desire these medications not because of their obesity or overweight status, but rather to achieve a further reduction in weight or reach a specific lower weight.

According to him, limiting access to these medications through insurance restrictions and budget cuts will have a significant impact on individuals who are experiencing health problems and a decreased quality of life due to their weight.

According to Dr. Shah, there are patients who have pre-diabetes, sleep apnea, and COPD, and are also dealing with obesity. These individuals, who weigh between 300 and 400 pounds, struggle to perform simple tasks without experiencing shortness of breath. For them, shedding off 30, 40, 50, 60, 70, or even 100 pounds would be a life-altering transformation. Not only would they have the potential to eliminate their need for oxygen therapy, but they may also be able to engage in more physical activity. However, the unfortunate reality is that their insurance providers do not cover the costs of such treatments.

Patients who are older and may not have the physical ability to exercise as much as they once did can find themselves in a frustrating situation. In such cases, medication for weight loss could serve as a viable alternative, according to Shah.

Medicare, a federal insurance program for individuals aged 65 and above, does not provide coverage for weight management medications. However, it does cover these medications for individuals with diabetes and heart disease.

Dr. Shah, a physician specializing in the treatment of medical obesity, acknowledges the challenges that come with providing effective options to patients. He highlights the frustrating reality of having to offer suboptimal choices due to insurance limitations. Despite knowing what the best course of action is, physicians often have to settle for less, compromising on the quality of care they can provide.

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