Jakob Emerson – Becker’s Payer Issues
As insurers continue to face major financial pressures related to covering weight loss drugs, many are steering more patients toward bariatric surgery to achieve similar results.
“Insurance companies are seeing that they’re getting more reliable outcomes and savings in the long run if they pay for someone to have bariatric surgery,” Christine Ren Fielding, MD, told Becker’s. Dr. Ren Fielding is a professor of surgery at NYU School of Medicine, the director of the NYU Langone Weight Management Program and chief of the system’s division of bariatric surgery.
“If you’re a responder to appetite control caused by a GLP-1, then there’s another treatment option that will do exactly the same thing: bariatric surgery. That includes Lap-Band, sleeve gastrectomy, and gastric bypass,” she said. “Bariatric surgery is the old-fashioned way. Insurers are now putting up barriers for people who want to be covered for GLP-1s and taking down barriers for people who want to have surgery.”
Weight loss medications such as Ozempic and Wegozy can cost upward of $10,000 a year. Insurers, health systems, state health plans and self-funded employers have all publicly grappled with how to cover the expensive medications, with some large organizations limiting coverage or dropping benefits entirely. Medicare is barred from covering GLP-1s for weight loss only, but does cover major bariatric procedures for patients that meet the requirements.
Among employer-sponsored plans, 34% say they offer coverage for GLP-1s for diabetes and obesity, while 63% say they cover bariatric surgery, according to a 2024 survey from the International Foundation of Employee Benefit Plans. Disease management for diabetes or weight loss is covered by 79%, nutritional counseling by 62% and lifestyle programs by 44% of employers.
In North Carolina, the state’s health plan for public employees stopped covering GLP-1s in April, but will continue to reimburse for bariatric procedures indicated for obese members. In Louisiana, Gov. Jeff Landry signed legislation in July that will require commercial insurers in the state to cover bariatric surgery for weight loss. The state already covers bariatric procedures for state workers and Medicaid enrollees.
The conversation has become more complicated through new research finding nearly six in 10 patients taking the drugs don’t reach a meaningful health benefit. Still, the popularity of GLP-1s has reduced the number of weight loss surgeries at some health systems far enough that they’ve stopped offering bariatric surgeries entirely.
“Sustaining people on these medications can oftentimes be difficult because they can’t get a certain dosage, which slows down the appropriate treatment,” Dr. Ren Fielding said. “You need access to consistency and the right utilization of these medications in order to gain a benefit. Sometimes there’s a better option.”
