Navigating coverage: A qualitative study exploring the perceived impact of an insurance company policy to discontinue coverage of antiobesity medication.

Introduction: Obesity rates continue to rise in the United States. Treatment includes modification of diet, exercise, behavioral modification and medical consideration including anti-obesity medications. However, multiple highly effective anti-obesity medications are expensive and with that we see insurers opting out of coverage of these medications. This has led to patients having to abruptly stop treatment with these medications. The purpose of this study is to explore the impact of non-medical discontinuance of obesity medication among patients in medical weight management programs. Methods: This is a qualitative descriptive study. Semistructured interviews were completed with participants in an academic medical weight management clinic. Interviews were recorded and transcribed. Themes were identified by members of the study team through qualitative content analysis. Participants were on or about to start anti-obesity medications and were from a single insurance company which cut coverage to all anti-obesity medications. Results: Twenty-two insured patients from across the state either currently taking or intending to take anti-obesity medications, participated. All participants were female. Few participants said they could afford the cost of the medication. Four main themes emerged: 1) Feelings of hope replaced by hopelessness upon loss of medication coverage, 2) Anger regarding the perceived injustice of anti-obesity medication coverage termination, 3) Perceptions of past and present stigma within the healthcare system and insurance company, 4) Generational influences on obesity treatment. Conclusion: Patients perceive the discontinuation of anti-obesity medication coverage as stigmatizing and unjust, leading to feelings of hopelessness and fear. With more insurance companies denying coverage for these costly medications more information is needed to identify best ways to address the loss of coverage with patients. Clinical management of these patients should incorporate evidence-based obesity treatments while navigating insurance constraints.