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NASHVILLE – Over the years, obesity-related coverage for state employees and Medicaid beneficiaries has expanded, according to researchers here.
Looking for adults covered by Medicaid heath insurance, coverage of multiple types of obesity prevention and treatments between 2009 to 2017, reported by Nichole Jannah, George Washington University in Washington, and colleagues.
This coverage has expanded, increasing by 133% during this time – from nine states to twenty-one states who offered coverage – and a 9% expansion in coverage for bariatric surgery, rising from 45 to 49 states offering coverage, No increase for pharmacotherapy (16 states in both plan years), they reported at ObesityWeek, a joint meeting of the Obesity Society and the American Society for Metabolic & Bariatric Surgery, and simultaneously Obesity.
However, Jannah told MedPage Today that it is "not surprised to find that obesity care remains patchy across states, or that many programs have been made available." She gives this to "fickle state budgets," which can lead to cutbacks and stipulations on coverage.
State employee health insurance programs and even greater expansions in coverage for obesity prevention and treatments during this time. Nutritional counseling coverage rose by 75%, while bariatric surgery coverage was 23%, and there was also a 64% increase in the proportion of states that provided pharmacotherapy coverage. In 2017, 42 states, 43 states, and 23 states reported nutritional counseling, bariatric surgery, and pharmacology coverage.
To assess pharmacotherapy coverage, the medical service provider, the service providers, the fee schedules, and other areas for data on Medicaid and state employee health insurance programs. Pharmacokinetics, including orlistat, lorcaserin, phentermine-topiramate, naltrexone-bupropion, liraglutide, benzphetamine, diethylpropion, phendimetrazine, and phentermine.
Nutrition-related coverage provided by a nonphysician provider, counseling from a dietitian, and medical nutrition therapy.
Coverage for bariatric surgery included laparoscopic gastric bypass, laparoscopic adjustable banding, laparoscopic gastrectomy, and open gastric bypass for severe obesity.
Jannah told MedPage Today her group was pleasantly surprised to find that overall coverage had widened for these evidence-based treatments. "This encouraging trend has been observed in the past, which has worked tirelessly to increase recognition of obesity as a complex, chronic disease, and to improve access to care for patients affected by obesity," she stated.
She also noted that she has a role in some bizarre coverage criteria. For example, some states require submission of full-body photographs with prior authorization requests for bariatric surgery coverage.
Another "noteworthy" restriction the group mentioned in the study included a provision limiting a number of beneficiaries to receive coverage for bariatric surgery, which was paired with steep cost-sharing, like state employees in Texas who had a $ 5,000 copay with 20% coinsurance for bariatric surgery.
In addition, 16 states had only one medical condition for pharmacotherapy, only 6 of these states actually offered reimbursement for 20-plus prescriptions of at least one particular drug over the course of 1 year.
"Jannah said," Our study suggests that it is all about having a comprehensive understanding of evidence-based clinical management, and that it is important to understand that. "At a minimum, states should ensure that they are eligible for reimbursement and that they are eligible for reimbursement.
She added that "States that offer coverage for behavioral, pharmacological, and / or surgical obesity treatments should be so based on evidence-based guidelines, enabling providers to furnish services at the recommended scope, duration, and intensity."
Jannah acknowledged that some adults will not seek treatment, but that they should not have access to "the full spectrum of treatment modalities," as well as the need for one-size fits-all approach. Coverage for a wide range of treatments will thus maximize the chances of a patient finding a sustainable management strategy to adhere to.
"In states where coverage is lacking, advocates point to progress when urging policymakers to rethink obesity care in state-funded health insurance programs," she suggests, highlighting that it's in the best interest to expand coverage for obesity treatments will ultimately save money.
It has been possible to assess the extent to which it is possible to assess the extent of the benefits associated with various restrictions.
The study was supported by Novo Nordisk.
Jannah disclosed no relevant relationships with industry. One co-authored reporting relationships with Weight Watchers and RTI.
2018-11-15T11: 00: 00-0500
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