Coverage for Obesity Prevention and Treatment Services: Analysis of Medicaid and State Employee Health Insurance Programs

Abstract

Objective This study examined changes in coverage for adult obesity treatment services in Medicaid and state employee health insurance programs between 2009 and 2017. Methods Administrative materials from Medicaid and state employee health insurance programs in all 50 states and the District of Columbia were reviewed for indications of coverage and payment policies specific to evidence‐based treatment modalities for adults (≥ 21 years of age) with obesity, including nutritional counseling, pharmacotherapy, and bariatric surgery. Results From 2009 to 2017, the proportion of state employee programs indicating coverage increased by 75% for nutritional counseling (from 24 to 42 states), 64% for pharmacotherapy (from 14 to 23 states), and 23% for bariatric surgery (from 35 to 43 states). The proportion of Medicaid programs indicating coverage increased by 133% for nutritional counseling (from 9 to 21 states) and 9% for bariatric surgery (from 45 to 49 states), with no net increase for pharmacotherapy (16 states in both plan years). Conclusions Coverage for adult obesity care improved substantially in Medicaid and state employee insurance programs since 2009. However, recommended treatment modalities are still not covered in many states. Where coverage has expanded, educating providers and beneficiaries on the availability and proper use of evidence‐based obesity treatments may improve health outcomes.

In‐patient obesity diagnosis, use of surgical treatment and associated costs by payer type in the United States: Analysis of the National Inpatient Sample, 2011 through 2014

“…The study period is limited to 2011 to 2014; the in‐patient claims data in the fourth quarter of 2015, and onwards used the ICD‐10 coding system that may cause discrepancies in identifying the obesity diagnosis. Finally, states differ in their coverage for obesity prevention and treatment services 31,42 ; however, the NIS data does not include state identifiers for the study years.…”

Patient initiation and maintenance of GLP-1 RAs for treatment of obesity: a narrative review and practical considerations for primary care providers

“…This in turn can only be fully appreciated if there is a thorough understanding of the physiological role of endogenous hormones such as glucagon-like peptide-1 (GLP-1) in regulation of appetite and energy intake. Limited health insurance coverage of AOMs may further limit patient access to GLP-1 receptor agonist (GLP-1 RA) medications [36]. It is also likely that there is insufficient understanding among PCPs as well as patients themselves that obesity is akin to other complex, chronic metabolic diseases such as hypertension, and therefore requires a similar intensification and chronicity of treatment.…”

Incorporating Weight Loss Medications Into Hepatology Practice for Nonalcoholic Steatohepatitis

“…The rationale for prescribing WLMs to most NASH patients who meet the established criteria is clear, and due to the significant number of NASH patients with fibrosis there is in fact some urgency in doing so . However, there are challenges in the use of WLMs in hepatology clinics.…”