Bariatric Surgery Gains Favor Over Costly GLP-1 Drugs for Obesity Treatment among USA healthcare Insurance Industry. There’s a growing trend in the world of medical insurance, particularly concerning obesity treatment.
As costs of Glucagon-like peptide-1 (GLP-1) agonists for weight management soar, some insurers are rethinking their coverage options.
This blog serves as a valuable reference point for Indian medical insurance companies navigating this evolving landscape.
The High Cost of GLP-1 Drugs Raises Concerns
While GLP-1 drugs demonstrate effectiveness in weight reduction and even reducing cardiovascular risks [1], their current price tags raise concerns about cost-effectiveness [1]. This has led some insurers to restrict or eliminate coverage for these medications altogether [1].
Bariatric Surgery: A Cost-Effective Alternative
Bariatric surgery, on the other hand, is considered a cost-effective approach for treating severe obesity, especially when combined with type 2 diabetes [2]. Studies have shown its efficacy in reducing weight, improving metabolic health, and lowering mortality rates in obese patients compared to lifestyle interventions alone [2]. Specifically, sleeve gastrectomy and endoscopic sleeve gastroplasty are both cost-effective options for moderate to severe and mild obesity, respectively [2].
The Financial Benefits of Bariatric Surgery for Insurers
The upfront cost of bariatric surgery falls between $17,000 and $26,000 [3]. However, insurers can recoup these costs within a two-to-four-year timeframe due to reduced spending on obesity-related conditions [3].
Shifting Tides in Insurance Coverage
The trend towards bariatric surgery is gaining momentum. Several insurance companies in the US are easing access to this procedure [4]. Examples include Blue Cross Blue Shield branches in Michigan, Massachusetts, and Vermont, as well as Geisinger Health Plan [4].
The North Carolina Case: Prioritizing Cost-Effectiveness
North Carolina State Health Plan exemplifies this shift. Citing the high cost of GLP-1 drugs (around $1,000 per month per patient) [5], the plan has removed coverage for these medications, including Wegovy and Zepbound [5]. Bariatric surgery, however, remains covered for those who qualify [5].
Similar Decisions Across the US Healthcare Landscape
The University of Texas health system, Ascension hospital chain, and the Mayo Clinic have all implemented similar measures, either stopping reimbursement for weight loss drugs or capping coverage amounts [6]. Notably, these entities continue to cover bariatric surgery [6].
Medicare Coverage and the Limited Role of GLP-1 Drugs
Medicare offers coverage for bariatric procedures like gastric bypass and laparoscopic banding under specific conditions related to morbid obesity [7]. However, coverage for weight-loss medications outside of specific cardiovascular indications remains unavailable [7].
Weighing the Options: Efficacy vs. Cost
Bariatric surgery offers superior weight loss results compared to medications, but carries a higher risk of complications [8]. Conversely, GLP-1 drugs are less invasive and have fewer side effects, making them appealing to patients [8].
Potential Long-Term Implications
This shift in policy might leave a significant portion of patients untreated if they are unable to afford bariatric surgery. While this approach saves insurers money upfront, the long-term consequences of untreated obesity could lead to increased healthcare spending in the future.
Looking Ahead: Considerations for Indian Medical Insurance Companies
Indian medical insurance companies can learn valuable lessons from these developments. As they navigate the obesity treatment landscape, factors like cost-effectiveness, long-term health outcomes, and patient preferences should be carefully considered. By implementing evidence-based coverage policies, insurers can ensure access to effective treatments while managing healthcare costs responsibly.
References:
[1] Medscape: https://www.medscape.com/viewarticle/glp-1s-obesity-your-questions-answered-2024a10002f0 [2] Modern Healthcare: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8884307/ [3] The New York Times: https://www.nytimes.com/2024/01/26/business/obesity-drugs-insurance-north-carolina.html [4] Ibid. [5] Ibid. [6] Cureus: https://www.cureus.com/articles/191260-navigating-bariatric-surgery-understanding-and-managing-short-term-and-long-term-complications?score_article=true [7] Medicare.gov: https://www.medicare.gov/coverage/bariatric-surgery [8] Ibid.