March 11, 2024
Payers | Tea Leaves
  • Health insurance companies are expanding their coverage of bariatric surgery amid rising demand for pricey new weight loss drugs. Geisinger Health Plan and Blue Cross and Blue Shield carriers in Massachusetts, Michigan, and Vermont are among those easing access to bariatric surgery over the past year as patients seek weight loss medications that can cost about $1,000 a month in perpetuity. Insurers say changes such as lifting prior authorization requirements and covering bariatric surgery for more conditions are merely the result of regular reviews and not a response to these new medications. However, some providers and policy experts observe that this more favorable approach to bariatric surgery coincides with the introduction of expensive drugs most patients must use indefinitely to sustain clinical benefits, at great cost to health insurers. Putting patients under the knife is comparatively cheaper, said James Chambers, a professor at Tufts Medical Center who studies insurance coverage of GLP-1s. (Article here)