Person:

Gomez, Gricelda

Objective: Obesity is now the most prevalent chronic disease in the United States, which amounts to an estimated $147 billion in health care spending annually. The Affordable Care Act (ACA) enacted in 2010 included provisions for private and public health insurance plans that expanded coverage for lifestyle/behavior modification and bariatric surgery for the treatment of obesity. Pharmacotherapy, however, has not been included despite their evidence-based efficacy. We set out to investigate the coverage of Food and Drug Administration-approved medications for obesity within Medicare, Medicaid and ACA-established marketplace health insurance plans.

Methods: We examined coverage for phentermine, diethylpropion, phendimetrazine, Benzphentamine, Lorcaserin, Phentermine/Topiramate (Qysmia), Liraglutide (Saxenda) and Buproprion/Naltrexone (Contrave) among Medicare, Medicaid and marketplace insurance plans in 34 states.

Results: Among 136 marketplace health insurance plans, 11% had some coverage for the specified drugs in only nine states. Medicare policy strictly excludes drug therapy for obesity. Only seven state Medicaid programs have drug coverage.

Conclusions: Obesity requires an integrated approach to combat its public health threat. Broader coverage of pharmacotherapy can make a significant contribution to fighting this complex and chronic disease.

Background: Patients who undergo bariatric surgery often have inadequate weight loss or weight regain. Objectives: We sought to discern the utility of weight loss pharmacotherapy as an adjunct to bariatric surgery in patients with inadequate weight loss or weight regain. Setting: Two academic medical centers. Methods: We completed a retrospective study to identify patients who had undergone bariatric surgery in the form of a Roux-en-Y gastric bypass (RYGB) or a sleeve gastrectomy from 2000– 2014. From this cohort, we identified patients who were placed on weight loss pharmacotherapy postoperatively for inadequate weight loss or weight regain. We extracted key demographic data, medical history, and examined weight loss in response to surgery and after the initiation of weight loss pharmacotherapy. Results: A total of 319 patients (RYGB 1⁄4 258; sleeve gastrectomy 1⁄4 61) met inclusion criteria for analysis. More than half (54%; n 1⁄4 172) of all study patients lost Z5% (7.2 to 195.2 lbs) of their total weight with medications after surgery. There were several high responders with 30.3% of patients (n 1⁄4 96) and 15% (n 1⁄4 49) losing Z10% (16.7 to 195.2 lbs) and Z15% (25 to 195.2 lbs) of their total weight, respectively, Topiramate was the only medication that demonstrated a stat- istically significant response for weight loss with patients being twice as likely to lose at least 10% of their weight when placed on this medication (odds ratio 1⁄4 1.9; P 1⁄4 .018). Regardless of the postoperative body mass index, patients who underwent RYGB were significantly more likely to lose Z5% of their total weight with the aid of weight loss medications.