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Arkansas Mandates Bariatric Surgery Coverage, Sidelines Ozempic
Arkansas enacts a new law requiring insurers to cover bariatric surgery for severe obesity while specifically excluding coverage for weight-loss drugs like Ozempic.
Key Points
- Arkansas enacts a new law requiring insurers to cover bariatric surgery for severe obesity while specifically excluding coverage for weight-loss drugs like Ozempic.
- The mandate applies to patients with a BMI of 40 or higher, or a BMI of 35 with related health conditions such as diabetes or sleep apnea.
- The policy prioritizes a one-time surgical procedure over costly, long-term medications as payers grapple with the high price of new weight-loss drugs.
A new Arkansas law, Act 628, now requires insurers to cover bariatric surgery for severe obesity, a move that prioritizes a one-time surgical fix over costly, long-term weight-loss drugs like Ozempic.
Drawing a line: The policy pointedly carves out any requirement for insurers to cover "injectable drugs... or any other drugs prescribed for weight loss." The move comes as payers nationwide grapple with the financial sustainability of medications that can top $1,000 a month.
Opening the doors: The new rules apply to anyone with a BMI of 40 or higher, or a BMI of 35-plus combined with conditions like diabetes or sleep apnea. The mandate also requires coverage for the full spectrum of related care, including all preparatory consultations and post-surgery follow-ups.
Arkansas is betting on a one-time fix for a chronic disease over perpetual medication. The state’s Department of Human Services and Insurance Department will now write the final rules for the law's implementation. The new demand is also fueling a market for specialized providers, with some touting themselves as the state's only accredited outpatient surgical centers built specifically for bariatric procedures.
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