Sunday, December 20, 2009

Diabetes Drug Might Be Weight Loss Solution; Will Insurance Cover It?

Thursday, December 10, 2009, 0:33
This news item was posted in medical insurance category and has 0 Comments so far.

A recent study gives some hope to the millions of people struggling with maintaining a healthy weight. Although few health insurers directly base their coverage decisions on a person’s weight, obesity often leads to other health problems that will cause premiums to skyrocket. Sometimes, these ailments will prevent someone from being able to buy health coverage altogether. Diabetes, specifically the type-2 variety, is one of the illnesses that can result in excess weight and higher costs for everyone (because everyone subsidizes part of diabetics’ treatment). It appears that a drug developed to treat diabetics can also result in weight loss; but will insurance companies pay for it? More importantly, does it even work?

Q: What is this potential miracle drug?
A:
The medical name for it is liraglutude, and it’s also sold under the brand name Victoza.

Q: How exactly does it work?
A:
Liraglutude is injected into the stomach every day, and works by imitating a gut hormone (GLP-1) that supposedly makes a person feel full through the reproduction of insulin. No longer hungry, the patient will eat less and lose weight as a result.

Q: How effective is liraglutude for obese individuals without diabetes?
A:
That’s currently unclear. The manufacturer-sponsored study found that it was significantly more effective than the oral obesity drug orlistat (also known as Xenical) or a placebo when combined with diet and exercise. According to the BBC, the study found that over 75% of the participants lost over five percent of their body weight–an average of 14 pounds. Ten percent of a person’s body weight is typically cited by physicians as the amount of weight loss that results in significant health benefits, so the potential benefits of liraglutude are a great start in cutting the health insurance costs resulting from obesity.

Q: How much does the drug cost, and will it be covered by my insurance?
A:
Currently, liraglutude is very expensive: about $828 for six months of treatment. I think it’s unlikely that the average health insurance plan companies would pay for it, unless you are either morbidly obese or also suffering from type-2 diabetes. Healthcare reform may also result in some insurers eliminating coverage for certain procedures and medications that are considered experimental or unproven, in an attempt to further reduce costs. At this point, liraglutude clearly fits into that category. Also, many insurance companies don’t even cover the more extensively studied Xenical, or its lower-strength OTC version Alli. If excess weight is your only major health problem, it will be difficult to get your insurer to cover weight loss treatments. Of course, for information about your specific plan, contact your insurance agent.

In my opinion, the jury is out on liraglutude. Further study is needed, so I suggest you wait and see. Obesity is a major health epidemic in America, and is a driver of the increase in medical costs. An effective health care reform solution must combat it, yet an investigational and costly injection probably won’t be the magic bullet. Meanwhile, continue with a healthy diet and exercise plan. Many insurance companies cover some or all of the cost for a gym membership and/or a nutritionist, since their benefits are proven.

(Image: Nolan O’Brien under CC 2.0)

Yamileth Medina is an up and coming expert on Health Insurance and Healthcare Reform. She aims to help people realize that they don’t have to go without a health insurance plan while waiting for a public option, if it ever gets passed. Yamileth lives in Miami, FL.

You can leave a response, or trackback from your own site.

Leave a Reply