Does insurance cover Ozempic, Wegovy? A lawsuit pushes for it

(NewsNation) — A Washington state nurse filed a class-action lawsuit claiming the state agency responsible for procuring health insurance for public employees discriminates against those struggling with obesity by neglecting to include weight loss drugs in its coverage. 

Insurance companies are not consistently covering these drugs like Ozempic, Wegovy and Mounjaro when they’re prescribed for obesity. Many patients are left grappling with the daunting costs, often surpassing $1,000 monthly. 

Jeannette Simonton, the plaintiff who initiated the lawsuit, has explored numerous avenues to address her weight.

She lost 80 pounds through the use of the drug Wegovy. The weight loss has dramatically improved her quality of life, enabling her to engage in previously challenging activities. 

However, her insurance does not cover the medication. 

“It has been so disappointing. Because I feel like they’re looking at me like I’m in a box. I’m a check on a statistic in a box,” Simonton said. 

Simonton’s doctor, Peter Billing, said weight loss drugs like Ozempic and Wegovy are essential for treating obesity, a medical condition with well-established biological markers. 

“It’s just discriminatory against people who are obese, and it’s totally wrong. It’s a medical disease that’s due to elevated insulin secretion. We show it in the labs that we draw,” Billing said. 

Simonton and her attorney, Ele Hamburger, allege that insurers are discriminating against those who are obese.

After the Affordable Care Act and with similar state laws, health insurance companies are no longer legally permitted to discriminate based on disability or serious health conditions. 

The focus should be on the medical effectiveness of the treatment, and given the scientific consensus backing the efficacy of these weight loss medications, the exclusion appears to be a form of discrimination, according to Hamburger. 

Billing said that there is a misconception these treatments are merely cosmetic rather than medical. 

“The thought is people are obese because they’re lazy. They don’t cut down on what they’re eating, and they don’t exercise. This couldn’t be further from the truth,” Billing said. 

Being overweight or obese can have a serious impact on health. Carrying extra fat leads to serious health consequences such as cardiovascular disease (mainly heart disease and stroke), Type 2 diabetes, musculoskeletal disorders like osteoarthritis and some cancers (endometrial, breast and colon), according to the World Health Organization. 

While diet and exercise are effective for some, severe obesity necessitates a more robust intervention, according to Billing. 

Washington state law designates obesity as a protected disability, although this safeguard is not universal across all states. 

“The science here is so clear-cut that the only reason for continuing to exclude this kind of treatment is discrimination. It’s discrimination on the basis of disability,” Hamburger said. 

In a nation with over 100 million clinically obese individuals, a pressing question emerges: Should health insurance providers foot the bill for weight loss medications?