Jeannette Simonton, who is 5 feet 2 inches tall and weighs 228 pounds, was prescribed the obesity drug Wegovy by her doctor in February. However, her insurance refused to cover the medication due to a blanket ban on weight-loss drugs. Now, she is suing the Washington State agency that provides health insurance for public employees, claiming that the state’s health plans discriminate against individuals seeking weight-loss drugs, which goes against state law that recognizes obesity as a type of disability. This case is significant in the ongoing debate over whether health insurance should cover obesity drugs.
Wegovy, a high-dose version of Novo Nordisk’s Ozempic, is an appetite-suppressing drug that has shown remarkable effectiveness in helping patients lose weight. However, the cost of covering these medications on a large scale in the US, where more than 100 million people are obese, would be substantial. While some payers have started covering obesity medications due to research suggesting long-term health benefits, others argue that they cannot afford to do so.
Simonton, a nurse, believes that the refusal to cover her medication is shortsighted, considering the potential consequences of not losing weight in the long run. The Washington State Health Care Authority, the agency Simonton is suing, has not commented on the case.
GLP-1s, a class of injectable drugs, including Wegovy, have been used to treat Type 2 diabetes for years but have recently gained recognition for their ability to reduce body weight. A limited number of people with Type 2 diabetes and obesity have access to GLP-1s through their health plans. However, federal law prohibits Medicare from covering weight-loss drugs due to their high costs.
Employers and state health insurance programs are also grappling with the decision to cover obesity medications. The cost of covering these drugs for state employees in Arkansas, where 40% have obesity, would amount to $83 million annually. Advocates for patients with obesity argue that there is bias and stigma at play when health plans perceive weight-loss treatment as unnecessary or purely cosmetic.
Simonton has struggled with obesity for many years and has experienced serious joint problems as a result. Since starting GLP-1 treatment in September 2022, she has lost 76 pounds and seen significant improvements in her quality of life. However, she has had to pay for the medication out-of-pocket, resulting in financial strain for her and her husband. Her lawsuit aims to secure coverage for Wegovy going forward and seek reimbursement for previous denials of coverage.
