Class Action Lawsuit Challenges Noncoverage Of Obesity Drugs

A recent class-action lawsuit filed in the United States District Court for the District of Maine could signal a shift in how health plans cover obesity-related treatments, specifically semaglutide drugs like Ozempic and Wegovy. Plaintiff Jamie Whittemore has alleged that Cigna Health and Life Insurance Company’s refusal to cover semaglutide drugs for obesity treatment represents disability discrimination under the Affordable Care Act (ACA).

Historically, obesity has been viewed as a lack of willpower or a risk factor for other conditions. However, attitudes are changing, and it is now increasingly recognized as a complex but treatable condition. The American Medical Association even described obesity as a “disease state” in 2013, emphasizing the need for a range of interventions, including drugs like semaglutide.

Whittemore’s case against Cigna focuses on the exclusion of coverage for semaglutide drugs when used specifically for obesity treatment. Despite the drugs being medically necessary, according to Cigna’s own policies, the health plan excludes coverage in cases of obesity treatment, creating a disparity in coverage depending on the condition being treated.

The lawsuit raises questions around whether obesity is considered a disability under Section 1557 of the ACA and if self-funded health plans are subject to this provision. The outcome of this case could set a precedent for how insurers and health plans handle coverage for obesity and related treatments, as the popularity of semaglutide drugs continues to grow across the country. Stay tuned for updates as this legal challenge unfolds.