Maine resident sues Elevance over lack of anti-obesity drug coverage
The plaintiff wants to represent a class of enrollees who suffer from the 'disability' of obesity.
A Maine resident is seeking class-action status for a suit accusing Elevance Health of discrimination because it declines to pay for Ozempic, Wegovy, Zepbound or similar prescription drugs for people who are obese.
People who are obese suffer from a disability, and a refusal to pay for prescription drugs that can reduce obesity is a form of discrimination against people with the disability of obesity, according to a complaint filed by Rebecca Holland Sept. 20 in the U.S. District Court for the District of Maine.
Hollland’s lawyers and representatives for Elevance could not immediately be reached for comment.
Holland works for a public school district in Falmouth, Maine, that gets health coverage through a state trust administered by Elevance. She has had a documented history of having a body mass index over 30 since 2013, according to the complaint.
Her doctor prescribed Wegovy for her. After her plan refused to cover Wegovy, she paid out of pocket for a similar generic medication created by a compounding pharmacy.
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She is alleging discrimination under section 1557 of the federal Affordable Care Act, which prohibits discrimination on the basis of disability.
She is seeking to represent a class consisting of all individuals in Elevance-administered or Elevance-insured plans that have excluded all coverage for anti-obesity prescription medications over the past four years; who have been or will be diagnosed with obesity by a medical provider; and who will need prescriptions to treat their obesity while they are enrolled in a plan insured or administered by Elevance.
In the past, plaintiffs have sued insurers and employer plan administrators over coverage for care for conditions such as autism and eating disorders.
Many patients who have taken Ozempic, other GLP-1 agonist drugs and other, related anti-obesity drugs are suing the manufacturers over concerns about conditions that they say are related to use of the drugs, such as stomach paralysis and bowel obstruction.
Eleanor Hamburger and Richard Spoonemore, two lawyers at Sirianni Youtz Spoonemore Hamburger who helped Holland file her suit against Elevance, previously helped Jamie Whittemore, an employee of the University of Maine system, file a similar suit in the federal court in Maine in June.
The Cigna case is still under way. Cigna Maine against Cigna. Cigna has asserted that obesity is not a physical impairment unless it’s caused by a distinct physiological disorder.