A Call for Consistency

Published in June 2014 Issue             

There is no scientific or medical basis for categorically excluding pharmacologic treatment for the disease of obesity from insurance coverage. Yet, Medicare continues this exclusion despite the evidence and a growing number of people who need to be treated.

Medicare needs to reverse this policy as they did for sex reassignment surgery, which until recently, had been banned from coverage for more than 30 years.

In what is being hailed as a groundbreaking decision, the Department of Health and Human Services (HHS) appeals board said sex reassignment procedures are medically necessary for people who do not identify with their biological sex. It said the current exclusion was no longer reasonable because the surgery is safe and effective and can no longer be considered experimental.

The same is true for pharmacologic treatment for obesity. Several drug treatments have been shown to be safe and effective through clinical studies and it is not reasonable to deny them to a population that needs more help than it is getting in battling the number one threat to public health.

Coverage for metabolic and bariatric surgery has improved over the years, but not nearly enough. Arbitrary exclusions remain on these proven treatments. For example, today, only 22 of 50 states have bariatric surgery listed as a covered benefit within the Affordable Care Act (ACA) and only five states provide coverage for weight loss programs.

This has to change. Hopefully, a new AMA resolution passed this week, and the classification of obesity as a disease by the largest physicians group, will help turn the tide. Please read more about the story in this issue of connect.

Kudos to Medicare for revisiting an outdated and ill-advised policy on sex reassignment surgery after more than 30 years. Letís hope it doesnít take another 30 years to get things right for obesity treatment. Our patients canít wait.