The increasing prevalence of overweight individuals and diabetes mellitus poses a significant global threat to healthcare. Many people find that losing weight is not easy, requiring commitment and a tailored approach. Fortunately, various weight loss programs and interventions are available, and some may be covered by insurance. This article explores the landscape of weight loss programs, prescription medications, and the extent to which insurance plans offer coverage.
Insurance Coverage for Weight Loss Programs
Navigating insurance coverage for weight loss programs can be complex, as policies vary significantly. Some insurers offer comprehensive benefits, while others have specific exclusions or limitations.
UnitedHealthcare
UnitedHealthcare, for instance, provides a program where eligible health plan members receive 100% coverage for the program, including a Success Kit. This kit typically includes a body weight scale, an electronic food scale, a balanced portion plate, and access to Fitness on Demand, all accessible through the program dashboard. Members usually receive the kit after attending their first live session with a coach, with delivery taking approximately 7-10 business days.
Aetna
In contrast, many Aetna plans specifically exclude services and supplies related to obesity treatment or weight control. Under these plans, claims for weight reduction medications and physician supervision of weight reduction programs may be denied. However, Aetna may consider up to 26 individual or group visits per 12-month period as medically necessary for weight reduction counseling in obese adults (BMI ≥ 30 kg/m2) by a recognized provider. It's also worth noting that many Aetna benefit plans may exclude coverage of weight reduction medications under the pharmacy benefit or the health benefits plan.
Blue Shield of California and Blue Shield Promise Medi-Cal
Blue Shield of California and Blue Shield Promise Medi-Cal members can access over 60 programs designed to promote healthier choices related to diet, exercise, sleep, and overall health. These programs range from general well-being and health risk management to treatment and reversal of chronic conditions like type 2 diabetes. Weight loss programs specifically help patients make lifestyle changes that promote a healthy weight, with coaching support and personalized plans to decrease cravings and hunger. Disease prevention programs target the reduction of risk for type 2 diabetes and heart disease, providing members with a health coach and an individualized plan addressing physical activity, nutrition, sleep, and stress management. Additionally, chronic condition reversal programs aim to reverse conditions like hyperlipidemia, hypertension, and type 2 diabetes with support from physicians, health coaches, and patient communities.
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SCAN Inspired
SCAN Inspired offers a Weight Loss Management benefit that covers reimbursement for initial enrollment fees in qualified weight loss programs. These programs typically include multi-session weight loss programs that focus on changing diet and activity habits, led by nutritionists, registered dietitians, or other certified healthcare professionals, and may be in-person or virtual. However, the reimbursement does not cover costs for food or meals.
UC San Diego Health
UC San Diego Health offers a medically supervised SLIM program covered by insurance. They also provide one-on-one consultations with weight loss experts, including physicians and registered dietitians, and a lifestyle medicine doctor who personalizes care. Their program includes group classes led by a physician and a health coach, with certified health coaches providing support for motivation, accountability, and behavioral strategies to promote weight management.
Prescription Weight Loss Medications and Insurance
Insurance plans may cover some prescription weight loss drugs, though Medicare often does not, even with a supplemental plan. Coverage can vary widely depending on the specific medication and the insurance provider's policies.
Common Weight Loss Medications
Several prescription medications are used as adjuncts to diet and exercise for chronic weight management. These include:
- Contrave: A combination of naltrexone and bupropion, used for adults with a BMI of 30 kg/m2 or greater (obese) or 27 kg/m2 or greater (overweight) with at least one weight-related comorbidity.
- Orlistat (Xenical, Alli): A reversible inhibitor of gastric and pancreatic lipases that prevents the absorption of fat. Xenical is available in 120mg capsules, while Alli is available over-the-counter in 60mg capsules. Xenical is approved for adolescents aged 12 years or older.
- Qsymia: A combination of phentermine and topiramate, used for adults with a BMI of 30 kg/m2 or greater (obese) or 27 kg/m2 or greater (overweight) with at least one weight-related comorbidity.
- Liraglutide (Saxenda): A glucagon-like peptide-1 (GLP-1) receptor agonist, administered as a once-daily injection, for chronic weight management in adults with obesity or who are overweight with comorbidities.
Important Considerations for Medications
- Didrex: Contains benzphetamine hydrochloride and is used as a short-term adjunct in a weight reduction regimen based on caloric restriction for patients with a BMI of 30 kg/m2 or higher. It is contraindicated in patients with advanced arteriosclerosis, symptomatic cardiovascular disease, moderate to severe hypertension, hyperthyroidism, and other conditions.
- Orlistat (Xenical): Is contraindicated in persons with chronic malabsorption syndromes and cholestasis. Supplementation with fat‐soluble vitamins (A, D, E, K) and beta carotene is recommended in some patients.
- Qsymia: Is contraindicated in pregnancy, glaucoma, hyperthyroidism, hypersensitivity to sympathomimetic amines, and within 14 days of taking monoamine oxidase inhibitors.
- Saxenda: Has a boxed warning stating that liraglutide causes thyroid C-cell tumors in rats and mice. It is contraindicated in patients with a personal or family history of medullary thyroid carcinoma (MTC) or in patients with Multiple Endocrine Neoplasia syndrome type 2 (MEN 2).
Checking Insurance Coverage for Wegovy®
Novo Nordisk, the maker of Wegovy®, offers a platform to check insurance coverage for the medication and access savings offers. The platform requires users to provide information about their insurance and personal details to determine coverage. If insurance coverage is not provided or immediate coverage details are unavailable, the platform may share options that could help. If coverage requires prior authorization, the healthcare professional will need to fill out a form and submit it to the insurance company for review.
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Alternative Approaches to Weight Loss
Besides traditional weight loss programs and medications, other approaches have shown promise in supporting weight management.
Medicinal Plants and Natural Treatments
Medicinal plants and natural treatments have gained popularity, particularly in treating diabetes. Different mechanisms for the anti-diabetic effect of plants have been proposed, including increased insulin release, reduced intestinal glucose absorption, and enhanced glycogen synthesis. However, scientific evidence for most of these plants is still incomplete.
Capsaicinoids
Capsaicinoids, found in chili peppers, may help support weight management by reducing energy intake. Studies have shown that capsaicinoid ingestion before a meal can reduce ad libitum energy intake.
Very-Low-Energy Diets (VLED)
Very-low-energy diets (VLED) can be used safely for up to 3 months in supervised conditions for patients who fail to meet a target weight loss using a standard low-fat, reduced-energy approach. Longer-term studies have demonstrated significant weight loss and improvements in blood pressure, waist circumference, and lipid profile following a VLED.
Indirect Calorimetry
Using indirect calorimetry to set energy goals in weight management programs has been shown to be effective. Participants who received personalized nutrition energy goals developed using measured resting metabolic rate (RMR) lost significantly more weight than those who received a nutritional message using a standard care equation.
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