U.S. GAO – Obesity Drugs: Few Adults Used Prescription Drugs for Weight Loss and Insurance Coverage Varied


What GAO discovered

The prevalence of weight problems, that’s, a physique weight better than what is taken into account a wholesome weight for a given top, was roughly 38 p.c amongst all US adults. UU., Based on the most recent nationwide estimates out there on the time of the GAO evaluation. This prevalence was comparable for adults with various kinds of medical insurance.

Prevalence of weight problems amongst American adults by sort of medical insurance, 2013–2016

Remedy for adults with weight problems could embrace a number of of 9 prescription drugs that the Meals and Drug Administration has permitted to manage weight (i.e. weight problems drugs), though comparatively few adults have used these drugs. Of an estimated 71.6 million American adults with weight problems, roughly 660,000 per yr, on common, used an anti-obesity drug from 2012 to 2016, in line with nationwide estimates. Amongst adults who reported attempting to drop extra pounds, about three p.c reported that they took prescription drugs to drop extra pounds between 2013 and 2016, in line with nationwide estimates.

Weight problems drug protection varies by various kinds of medical insurance, together with Medicare and Medicaid. The plans cited elements corresponding to low shopper demand and strong proof supporting different remedies of their protection selections. The GAO evaluation of knowledge from the Facilities for Medicare and Medicaid Providers signifies that some Medicare prescription drug plans and state Medicaid applications reimbursed some weight problems drugs in 2016 and 2017. Insurance coverage plan protection Personal doctor additionally diversified, and plans could require the affected person to acquire prior authorization for drugs to be coated, in line with insurance coverage firm officers and pharmacy profit managers interviewed by GAO. For instance, insurance coverage firm officers stated a few of their plans solely cowl weight problems drugs after a affected person has tried different therapy choices, corresponding to behavioral counseling.

Why did GAO do that research?

Weight problems has been related to an elevated threat of growing circumstances corresponding to coronary heart illness, stroke, diabetes and sure sorts of most cancers. Remedy choices for individuals with weight problems embrace way of life remedy, corresponding to weight-reduction plan, train and behavioral counseling; medication for weight problems; surgical procedure; or a mixture of those efforts. The Bipartisan Finances Act of 2018 (P.L. 115-123) included a provision for the GAO to evaluate the prevalence of weight problems and the use and insurance coverage protection of weight problems drugs.

This report examines the prevalence of weight problems in the US and what’s identified concerning the use and protection of medical insurance for anti-obesity drugs, amongst different targets.

GAO examined knowledge from the Division of Well being and Human Providers (HHS) companies on the prevalence of weight problems (utilizing estimates for 2013 by way of 2016) and the use, expense and protection of weight problems drugs; performed a evaluate of the literature of related research printed from January 2012 to January 2019 in peer-reviewed publications and different publications; reviewed remedy varieties for chosen well being plans; and reviewed paperwork and interviewed federal company officers and stakeholder organizations (together with medical associations, advocacy teams, pharmacy profit managers and insurers).

HHS offered technical feedback on a draft of this report, which had been integrated as applicable.

For extra data, contact John E. Dicken at (202) 512-7114 or dickenj@gao.gov.

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