Why Insurers
Don't Cover Weight
Loss Medications

Table of Contents

Weight loss is daunting for many people. Plus, it can be more difficult for some people than for others based on a few
interacting factors: diet, exercise, and individual metabolism. These factors can affect progress toward weight loss goals. Although diet and exercise remain the traditional and most common methods used to maintain a healthy weight, new advances
in clinical medicine have provided several weight-loss medications that can also help.

One such innovation is the introduction of diet pens. Let’s explore the purpose and function of diet pens and how they compare to other available weight loss medications. Then we’ll address that looming question …why are these highly effective injectable or oral medications not always covered by health insurance?

What are Diet Pens?

Obesity is an epidemic, and in the world of weight loss and obesity management, there is a constant search for practical solutions. One innovative solution has come with the introducing of “diet pens,” which involve injectable medications designed to help with weight loss. These pens are not magic wands but supplements to a structured weight loss regimen with multiple components.

One of the diet pens on the market is Saxenda®, a medication with the active ingredient liraglutide. Another example is Wegovy®, with the active ingredient semaglutide. While the term “diet pen” might make you think of a writing implement, in reality, it’s a pen-like device used to inject medication under the skin.

Saxenda® (liraglutide) and Wegovy® (semaglutide) are medicines people can take to help them lose weight. Our stomach sends signals to our brain when it’s time to eat. Liraglutide and semaglutide support our stomach to send these signals a bit slower, making us feel full longer. So, when someone uses liraglutide, they might not feel as hungry and may eat less, which can help them lose weight.

Through a reduction in appetite, diet pens can be an essential supportive component in weight loss when combined with other lifestyle changes, like following a healthy diet and increasing exercise time and frequency.

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How are Diet Pens Used?

Diet pens are easy to use, and detailed instructions are provided with each product. It’s important to use diet pens under the guidance of your doctor or other healthcare provider.

The medication in a diet pen is typically administered once a day (as with Saxenda®) or weekly (as with Wegovy®). A single prescription for a diet drug typically provides a 30-day supply. The most common side effects are gastrointestinal issues and include nausea, diarrhea, constipation, indigestion, and abdominal or stomach pain.

It’s important to know how to administer a weight loss medication correctly and follow the recommended dosing schedule for both your safety and to ensure effectiveness of your treatment. Take time to understand how the pen works and be sure to store it under the proper conditions.

Who are Diet Pens Prescribed For?

Diet pens are typically prescribed for individuals who have not had success with traditional weight loss methods or have specific health conditions that make weight loss more challenging. These pens are not general solutions for anyone looking to shed a few pounds or for those who have not tried other methods of weight loss first. These weight loss medications are specifically designed for people with serious weight-related health concerns.

Other Weight Loss Medications

The injectable preparations of liraglutide and semaglutide available in pen format that are approved for use in weight loss are Saxenda® and Wegovy®, as discussed above. Another injectable preparation of semaglutide in pen format is Ozempic®, although it is only approved for use in managing type 2 diabetes. Even though it shares the same active ingredient as Wegovy®, the prescription of Ozempic to treat obesity and support weight loss would be off-label use.

Weight loss medications, including those in diet pens, are highly effective. Drugs like tirzepatide have stood out for their substantial weight loss results without significant side effects.

While diet pens with Ozempic are designed for the treatment of type 2 diabetes, they may have a secondary effect of treating another condition, such as obesity, and also support weight loss. This dual purpose can be beneficial for those suffering from co-morbid conditions. Plus, the use of pens makes the administration of these medications more manageable, especially for those who might be squeamish about standard injections.

Traditional oral weight loss medications, include:

Bupropion-naltrexone (CONTRAVE®) is a combination of an opioid receptor antagonist and an antidepressant that disrupts inhibitory feedback. Bupropion affects the pleasure-reward areas of the brain. One effect of the medication is reduction in appetite. Common side effects include nausea/vomiting, constipation, headache, and dizziness.

Orlistat (XENICAL®, alli®) is a weight loss medication that blocks the absorption of dietary fats to promote weight loss. The most common side effects are gastrointestinal issues that may include oily spotting, oily stool, increased frequency of bowel movements, gas, bloating, and abdominal discomfort.

Phentermine-topiramate (Qsymia®) is an appetite suppressant that affects the central nervous system. Its mechanism is
different from injectables like Ozempic, as it directly influences appetite signals in the brain to promote weight loss. Common side effects include dry mouth and constipation.

For any medication, side effects are a concern, and injectable weight loss medications have shown fewer severe side effects overall compared to many of the orally administered diet drugs. Convenience around frequency of administration is also a notable difference between medications. While some diet pens, like Saxenda®, require daily injections, others, like
Wegovy®, require injection only once a week. Oral diet medications are commonly prepared as a daily dose. This frequency can influence decisions about which medication to choose, as more frequent dosing may reduce compliance with the
treatment plan.

We now know that many drugs are available and approved for use in treating obesity by promoting weight loss. We also
know that being overweight or obese can have long-term consequences on overall health and lead to a number of metabolic issues, joint problems, heart disease, and other cardiovascular complications. So, the remaining question is …

Why Aren’t Weight Loss Medications Covered by Health Insurance?

Weight loss medications, despite their potential benefits, often find themselves on the list of treatments not covered by health insurance companies. Coverage varies between insurance providers, types of medications covered, and even criteria that may need to be met for a patient to qualify for coverage for a specific weight loss drug. Therefore, some insurance plans may cover your preferred treatment, but do your research to find out for sure because there has historically been significant resistance to coverage for weight loss drugs.

The reluctance of insurers to provide coverage for these medications is rooted in a mix of financial concerns, historical perspectives, debates over disease classification, and the overall approach to health management. Let’s unravel the reasons behind this controversial stance.

Classification of Obesity

One of the primary reasons for non-coverage is the way people think about obesity. Some insurance companies argue that obesity is not an actual disease but rather a result of behavioral issues such as poor diet and lack of exercise. This viewpoint suggests that individuals are responsible for their weight challenges and categorizes obesity as a self-inflicted condition rather than a medical illness that requires treatment.

Historical Precedence and Trust

Past experiences with weight loss drugs have created a loss of trust. Some medications that were initially introduced with much fanfare were later found to have severe side effects or were not as effective as originally thought. For example, certain weight loss drugs were found to damage heart valves. Such historical precedents make insurers cautious about covering new medications.

Financial Concerns

The rising demand for weight loss drugs has led to increased costs for insurers. As more and more people turn to these medications, insurance companies fear escalating costs. In response, some employers have even stopped insurance coverage for weight loss medications to control costs.

Effectiveness and Long-Term Benefits of Treatment

Insurers often evaluate the long-term benefits of treatments. While weight loss drugs may offer short-term weight reduction, there’s skepticism about their long-term effectiveness. The worry is that once the medication is stopped, the individual might regain the lost weight, making the treatment temporary and not cost-effective from the insurer’s perspective.

Alternative Treatments

Weight loss can be achieved in multiple ways, including through diet, exercise, and lifestyle modifications. Insurance companies might be more inclined to cover interventions like counseling or programs that promote lifestyle changes instead of medications, viewing them as more sustainable and holistic solutions.

Loopholes and Conditions

There may be ways to secure weight loss drugs through indirect routes. Many insurers don’t provide blanket coverage for weight loss drugs, but they might cover them under specific conditions or through certain loopholes. For example, if obesity is leading to other health complications, such as heart disease or diabetes, an insurer might be more inclined to provide coverage as a way to mitigate the more severe health risks.

Before adding any medication to their list of covered drugs, insurance companies undergo a rigorous evaluation process. This involves analyzing clinical trial data, understanding side effects, assessing the demand, and more. The stringent nature of this process can often delay or prevent the addition of weight loss medications to insurance coverage. Public Programs and Coverage

Public insurance programs, such as Medicare and Medicaid, have their criteria and lists of covered medications. These programs often do not cover weight loss drugs, setting a precedent that private insurers might follow.

Conclusion

The issue of why health insurers often don’t cover weight loss medications is multifaceted. Despite the proven effectiveness of weight loss medications like diet pens, there are several factors contributing to this coverage gap.

From the view that weight gain and obesity a self-inflicted, personally controllable occurrences of bad past experiences in
covering drugs that had severe side effects, skepticism about the effectiveness of treatment, and rising costs of covering treatment for such a common condition, there are high barriers to blanket approval of coverage for weight loss drugs.

While the landscape is gradually changing with more understanding of obesity as a medical condition and the advent of safer and more effective drugs, it may take time before these medications become a standard part of insurance coverage.

Written & Reviewed By
The Diet Pens Team

The Diet Pens Team is a dedicated group of healthcare enthusiasts, nutritionists, and local pharmacists committed to providing the latest and most accurate information about diet pens and weight management. Our team combines years of expertise in healthcare and nutrition with a passion for helping individuals achieve their health goals.

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