OBJECTIVES: Obesity has become a significant health concern due to the prevalence and co-morbidities associated with it. Prior research shows anti-obesity medications are safe and effective as a treatment. This study aims to assess the relationship between body-mass index (BMI) and healthcare costs, and understand how often anti-obesity drugs are denied.

METHODS: A retrospective database analysis was performed using 2020 pharmacy and medical reimbursement data for adults 18 and over from New Hampshire. The data set contains commercial and Medicare supplement claims from large payers within the state and includes payments made by insurance companies and members. Pharmacy claims were analyzed to determine how frequently four anti-obesity medications (AOM) were denied. Medical claims were evaluated to assess the relationship between BMI and healthcare costs. Medical claims were included in the analysis if they contained an ICD-10 code for BMI and were categorized into four cohorts (non-obese, Class 1 obesity, Class 2 obesity, Class 3 Obesity). The medical and pharmacy data were analyzed at a claim level so a person could appear multiple times in the data.

RESULTS: 4,588 pharmacy claims contained one of four AOMs being evaluated. Overall denial rate for these medications was 64.0% ranging from 58.9% to 70.3%. 60,415 claims included an ICD-10 code for BMI. The average medical claim cost was almost double when comparing non-obese ($1,243) to obese ($2,439) claims. As the class level of obesity increased so too did average medical claims costs (Class 1 - $1942, Class 2 - $2,138, Class 3 - $2,970).

CONCLUSIONS: Health insurance payers frequently deny AOMs despite the higher cost of healthcare for obese individuals. Benefit plans should increase coverage AOMs for individuals who are indicated as overall costs are likely to be higher than reported here as indirect cost were not evaluated.