by Jinghong Chen
While about 38% of U.S. adults are obese, and the FDA has approved nine drugs to help treat obesity, relatively few people — about 660,000 annually — were estimated to have used an obesity drug between 2012 and 2016, according to a Government Accountability Office (GAO) report released Aug. 9. The GAO noted that coverage of obesity drugs varied across different types of health insurance. Patients’ out-of-pocket payments made up most of the expenditures for these drugs (68%), while private insurers covered 25%, Medicaid 4% and Medicare 2%. State Medicaid programs or Medicaid managed care plans within states could choose to either cover or exclude obesity medications. In 2016 and 2017, over half of the prescriptions reimbursed under Medicaid were for the genetic obesity drug Phentermine.
NOTES: The Medicaid amount reimbursed includes state and federal reimbursement and dispensing fees. These amounts do not include all Medicaid spending for obesity drugs under Medicaid managed care — because managed care organizations can be paid for the drugs as part of their capitated payment for all Medicaid services, they are not reimbursed on a per-drug basis, and their payment amounts are not recorded as amounts reimbursed in CMS’s Medicaid State Drug Utilization data. The number of prescriptions reimbursed includes 144 prescriptions for obesity drugs that showed zero dollar amounts for Medicaid reimbursement in CMS’s Medicaid State Drug Utilization data.
SOURCE: U.S. Government Accountability Office, “Few Adults Used Prescription Drugs for Weight Loss and Insurance Coverage Varied.” Visit https://www.gao.gov/assets/710/700815.pdf.