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Washington nurse sues state health authority over obesity drug coverage


Jeannette Simonton, a nurse in Washington State, has initiated a lawsuit against the Washington State Health Care Authority for its refusal to cover her obesity medication, Wegovy. The lawsuit was filed on Tuesday and is represented by the law firm Sirianni Youtz Spoonemore Hamburger. The case argues that the refusal to cover the drug contravenes Washington State’s anti-discrimination law, which recognizes obesity as a disability. This legal dispute could potentially establish a precedent regarding health plans’ coverage of obesity drugs.

Simonton has lost 76 pounds since she started taking an obesity drug called Mounjaro, produced by Eli Lilly (NYSE:LLY), last year. However, the cost of these medications has been a burden for Simonton as she had to bear the out-of-pocket costs herself. Wegovy, another obesity drug produced by Novo Nordisk (NYSE:NVO), costs over $16,000 annually.

The high cost of these effective weight loss drugs, known as GLP-1s, poses financial challenges not only for individuals but also for employers and government programs. Medicare, a federal program, currently prohibits paying for weight loss drugs due to these high costs. While some insurers have begun covering these drugs, others argue they cannot afford it.

Simonton’s case is part of a broader debate about the long-term costs of not addressing obesity. If Medicare were to cover obesity drugs like Wegovy and Mounjaro, it could face an annual expenditure of approximately $27 billion. States with substantial proportions of obese state employees, such as Arkansas and Wisconsin, face similar challenges according to the Institute for Clinical and Economic Review.


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