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The Right to Coverage for Obesity Treatment

The Right to Coverage for Obesity Treatment

All people living with obesity have the right to the full contingent of treatment options for their disease as prescribed by their physicians through health insurance that is widely available, comprehensive and affordable.

Today, many employers and both public and commercial insurers exclude obesity management services or place access barriers that delay or deny treatment. Consequently, obesity remains largely undiagnosed and undertreated, leading to higher rates of costly chronic diseases.

To change this situation, obesity should be a covered benefit in health insurance so those with the disease are afforded the same rights and access to care as they are for other chronic diseases. Therefore, adults with obesity must demand the right to:

  • Comprehensive coverage for obesity prevention, treatment, and care as an essential health benefit required for all health plans.
  • Comprehensive coverage for obesity treatment under Medicaid plans.
  • Medicare policies that are equitable for all older adults. This requires modernizing the outdated interpretation of Medicare Part D rules that exclude coverage for FDA-approved anti-obesity medications (AOMs) and Medicare Part B rules that restrict access to intensive behavioral therapy solely to primary care providers.
  • Coverage that considers obesity treatment as a personal decision that is best left to the individual and his/her healthcare provider.
  • Coverage that removes discriminatory benefit design language from health plans, which severely restricts obesity treatment services. This means ending lifetime limits on treatment, caps on the number of visits (for example, one dietitian visit a year), high co-pays and deductibles, and policies that require step-therapy or an overly burdensome preauthorization process.
  • Coverage allowing the individual to be referred to and treated by a credentialed health provider trained in obesity care.
  • Coverage allowing the individual to receive support from a health educator trained in obesity care.
  • Benefit from the discounts and rebates their health plan receives from drug manufacturers to lower the cost of anti-obesity medicines.
  • Patient assistance programs for anti-obesity medications to make these medications equitable and affordable for adults with lower incomes.
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