Coverage for weight-loss drugs

I’d like to try the drug phentermine to lose weight, but my doctor says that my health plan won’t cover it.  Why not?

Slim Diva To Be

Dear Slim Diva To Be,

Phentermine was part of the Fen-Phen drug that was taken off of the market in 1997, when it was found to cause heart valve problems. It was still available even after Fen-Phen was taken off the market, as a stand-alone drug (not compounded). However, it was a designated as a Schedule IV controlled substance and prescribing was restricted accordingly. An example of a Schedule IV drug is a narcotic.  Your doctor cannot prescribe phentermine except in specific circumstances, and he feels that yours does not qualify.  Your plan would cover it, if you met the criteria for needing this type of drug.

Don’t despair yet, however!  A drug containing phentermine has been approved by the FDA. In July 2012, Qsymia was approved for the treatment of obesity. Once the new drug hits the market and starts getting prescribed, your plan will very likely cover it. Health plans generally cover FDA approved drugs.  It’s not clear whether plans could limit how much of this drug they pay for, under the Affordable Care Act.  But they can put a pre-approval on it.

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Linda Riddell

About Linda Riddell

A published author and health policy analyst with 25 years’ experience, Linda Riddell's goal is to alleviate the widespread ailment of not knowing what your health plan can do for you.