Jeannette Simonton, a nurse in Washington State, is suing the agency that purchases health insurance for public employees after her insurance refused to cover the obesity drug Wegovy. Despite being a qualified candidate for the medication due to her high body mass index and serious joint problems, her insurance claimed a blanket ban on covering weight-loss drugs. Simonton’s lawsuit highlights the debate over whether health insurance should cover obesity drugs, which can be expensive considering the high number of obese individuals in the United States. While some payers argue that the drugs are cost-effective in the long run, others claim they cannot afford to cover them. Wegovy, a high-dose version of Novo Nordisk’s drug Ozempic, costs over $16,000 per year. The lawsuit will be closely observed as a test case for health plans’ ability to deny coverage for obesity drugs.
