Class Action Lawsuit Challenges Noncoverage Of Obesity Drugs

Recently filed in the United States District Court for the District of Maine is a class action lawsuit that could be a sign of future legal challenges to come. The lawsuit, Whittemore v. Cigna Health and Life Insurance Company, alleges that Cigna has engaged in disability discrimination under the Affordable Care Act (ACA) by refusing coverage for semaglutide drugs used to treat obesity in the health plans it administers.

Semaglutide drugs, such as Ozempic and Wegovy, have been gaining popularity across the country as a treatment for obesity. However, not all health plans currently cover these drugs, leading to increased pressure on insurers and health plans to reassess their coverage policies.

In Whittemore’s case, she was enrolled in a health plan administered by Cigna and sought coverage for obesity treatment medications. However, Cigna declined coverage under the plan, citing an “Obesity Exclusion” that specifically excludes coverage for medications like semaglutide drugs when used to treat obesity.

The lawsuit argues that by excluding coverage for obesity treatment in their health plans, Cigna is engaging in disability discrimination under the ACA. The complaint points to a societal shift in how obesity is perceived, from a risk factor to a complex and treatable condition. Semaglutide drugs mimic the body’s natural appetite regulator and have shown promise in treating obesity.

At this early stage, questions remain about the lawsuit, such as whether obesity will be considered a disability under the ACA’s Section 1557. Additionally, it is unclear if self-funded health plans would be subject to Section 1557 if obesity is deemed a disability.

As more cases challenge noncoverage of semaglutide drugs like Ozempic and Wegovy, insurers and health plans may need to reevaluate their policies to avoid potential legal challenges.