by Mollie McCartney Cecil
On Feb. 28, PEIA announced that it was going to stop coverage of anti-obesity medications effective March 15. This includes both pill and injectable forms of medicines.
Prior to this, PEIA was severely restricting access to these medicines. Only a small group of clinics in the state could prescribe them. If a medication was prescribed by another clinic — even if it was by the patient’s long-time primary care provider or another board-certified obesity medicine specialist — it was denied coverage by PEIA. These medications are powerful tools in obesity treatment. They are also beyond the financial reach of most West Virginians unless they have insurance coverage for them.
All major medical associations recognize obesity as a chronic disease process. These include the American Medical Association, the American Association of Nurse Practitioners and the American Academy of Physician Associates. It is a disease process that is separate from its complications, such as diabetes, high blood pressure and heart disease.
Despite this accepted medical science, many insurance companies continue to view obesity as a lifestyle choice. Additionally, they do not prioritize the treatment of obesity as a critical aspect of population health improvement. As a result, they deny essential and evidence-based coverage of these medications.
An extensive library of evidence supports the use of a multi-faceted approach to obesity treatment. This includes diet, physical activity, behavioral modification and medical interventions used together. We now have several medications to treat obesity that are proven to be safe and effective and to decrease the long-term complications of obesity. When insurances exclude anti-obesity medications from their coverage, they are depriving patients with obesity of the most effective and appropriate treatment for obesity. Insurers such as PEIA who do this also limit treatment for obesity in a way they do not limit treatment for other chronic disease processes.
West Virginia has the highest rate of obesity in the nation. We have high rates of complications and death as a result. As of 2017, we led the nation in deaths from diabetes. We lead the nation in rates of heart attack and are in the top-five states in the nation for the prevalence of diabetes, stroke and cancer.
In our state, these conditions are usually the result of obesity. We can improve these numbers by using the full toolkit of obesity treatments. This would save countless lives and enable our citizens to live life to the fullest.
PEIA provides coverage for over 200,000 state employees and retirees as well as their dependents. This is a large part of our state’s residents. As a result, PEIA is uniquely positioned to improve health outcomes for a large part of our state’s population. PEIA could finally move the needle on the health problems that we have been fighting for decades. To do this, PEIA needs to cover all obesity treatments.
I have lived in West Virginia my entire life. My ancestors first settled in the Mountain State in the 1790s and my love for this state and my roots run deep. I, and my colleagues who choose to serve our state as health care clinicians, deeply care about West Virginians. We all hear the statistics about how West Virginia is failing to meet health goals. We want our fellow West Virginians to live long, healthy lives free from preventable disease and disability. I sincerely hope PEIA, and other insurers responsible for the health of our citizens, reconsider these policies.
