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Drug Benefit News

  • October 2014

January 24th, 2014

Aetna Tests the Weight-Loss Drug Waters With New Pilot and Pharma Collaboration

While many insurers and plan sponsors have been taking a “wait-and-see” approach to two relatively new anti-obesity medications, all eyes may now be on Aetna Inc. as it embarks on a clinically supported pilot to test the benefits of Vivus, Inc.’s Qsymia (phentermine and topiramate extended-release) and Eisai Inc.’s Belviq (lor- caserin HCl). The newly launched program, which is the first partnership of its kind for the drug makers, will evaluate the benefits of either agent “combined with lifestyle support.”

Qualifying members of self-insured plans that participate in the pilot will receive the drugs at a preferred brand copay and have access to mobile and other applications to help them stay on track with fitness, diet and other lifestyle goals. Doctors must prescribe the drugs, and Aetna will apply prior authorization criteria that are consis- tent with the drugs’ approved use by adult patients with an initial body mass index
of 30 or greater or overweight adults with a BMI of 27 or greater who also suffer from at least one weight-related comorbid condition (e.g., high blood pressure, high cho- lesterol, type 2 diabetes). Aetna will provide information about weight-loss options to all employees of plan sponsors who chose to participate in the pilot, and will conduct outreach to high-risk members about their covered weight-loss options through exist- ing wellness programs.

This is the first time Aetna is testing anti-obesity drugs as part of an overall weight- loss management program, which includes the use of CarePass, an application that allows members to “choose from curated applications in the areas of weight tracking, medication compliance, creating and following a physical activity plan and following a…

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