OBJECTIVE: Obesity is now the most prevalent chronic disease in the United 
States, which amounts to an estimated $147 billion in health care spending 
annually. The Affordable Care Act (ACA) enacted in 2010 included provisions for 
private and public health insurance plans that expanded coverage for 
lifestyle/behavior modification and bariatric surgery for the treatment of 
obesity. Pharmacotherapy, however, has not been included despite their 
evidence-based efficacy. We set out to investigate the coverage of Food and Drug 
Administration-approved medications for obesity within Medicare, Medicaid and 
ACA-established marketplace health insurance plans.
METHODS: We examined coverage for phentermine, diethylpropion, phendimetrazine, 
Benzphentamine, Lorcaserin, Phentermine/Topiramate (Qysmia), Liraglutide 
(Saxenda) and Buproprion/Naltrexone (Contrave) among Medicare, Medicaid and 
marketplace insurance plans in 34 states.
RESULTS: Among 136 marketplace health insurance plans, 11% had some coverage for 
the specified drugs in only nine states. Medicare policy strictly excludes drug 
therapy for obesity. Only seven state Medicaid programs have drug coverage.
CONCLUSIONS: Obesity requires an integrated approach to combat its public health 
threat. Broader coverage of pharmacotherapy can make a significant contribution 
to fighting this complex and chronic disease.