1. What is the decision or change (e.g., clinical topic, practice guideline, system design, delivery of care) you are facing or struggling with where a summary of the evidence would be helpful?

Lack of insurance coverage of weight loss drugs as life limiting healthcare disparity creating barriers to care and inequity in treatment

2. Why are you struggling with this issue?

Lack of less invasive non-surgical, yet more effective methods of treating obesity (a recognized, coded disease) creates disparities in care and not only prohibits effective treatment for many people, but is refusal to treat a medical condition with approved medications that have other beneficial effects for the population treated. Given a particular drug has shown a reduction in blood sugar, BMI, and cardiovascular protective effects, all sequelae of obesity, it should be available as a treatment for people who meet the need. This is not the cosmetic 10 lbs. as an example I have lost 36% of my BMI on this medication. I have been paying more than 2000$ a month and/or resorting to unsafe compounded drugs. I cannot afford to keep going much longer, and I suspect this will be determined to be a lifetime medication need to control a disease process. Only people with money deserve to live longer? Only people who already cross the threshold of diabetes and are down a path of obesity related disease sequelae that limits life quality and expectancy should be treated? This is not only true of obesity drugs, but many things are covered for men, like penile implants and erectile dysfunction medications, but hormone replacement therapy for menopausal women may or may not be covered. Plastic surgery is not covered, even if it is related to significant body changes such a weight loss and contributes to depression, anxiety or sexual dysfunction. An erection or the ability to have one is not life limiting, it may cause depression, or low self esteem, but so can many things that are fixed with plastic surgery. Sexual intercourse for men is no more important than for women. Men do not die if they cannot get an erection, yet we pay to treat it. Even if he is elderly. Why do we not treat women the same way? Deciding who lives, who dies, who is allowed the maximum enjoyment of life should not be up to dollars and cents in companies making billions in profits.

3. What do you want to see changed? How will you know that your issue is improving or has been addressed?

Insurers don't get to pick and choose what drugs a covered if there is medical necessity. The most effective and best drug for the patient as determined by their physician and medical condition should be covered. Healthcare disparities come in all forms and variation in the continuum of care. Decisions for coverage should not be a solely profit driven process that only the insurers get to decide who is worth treating and who gets to live a fuller, healthier, happier life. All disparities need to be stopped.

4. When do you need the evidence report?

Fri, 02/20/2026

5. What will you do with the evidence report?

Coverage decisions and appeals

Optional Information About You

What is your role or perspective? Patient Safety

If you are you making a suggestion on behalf of an organization, please state the name of the organization FL

May we contact you if we have questions about your nomination? Yes