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Diet, Nutrition & Weight Loss
Reply to "Any Feds on Wegovy or Saxenda? "
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[quote=Anonymous]Fed guidance doesn't say they can't exempt them. It says they have to provide "adequate coverage" for anti-obesity therapies...and a payor will find a lot of ways to provide "adequate coverage" that aren't what you think they should be. I would broadly expect that if you aren't clearly within the prescribing guidelines you won't be covered. Meaning you won't get coverage for wanting to lose 20-30lbs...you will have to meet the labeling guidelines for BMI or medical conditions exacerbated by BMI. These drugs are expensive and while there are definitely value arguments to made, insurers will try to find a lot of reasons to not cover them if they can. [/quote]
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