A Yarmouth woman filed a federal class-action lawsuit against Cigna Health and Life Insurance Co. for denying coverage of a weight-loss drug her doctor prescribed to treat obesity.
Jamie Whittemore filed the lawsuit Tuesday in U.S. District Court in Portland, arguing that the Affordable Care Act requires plans to cover weight-loss medications for obesity and that it is illegal to discriminate based on a medical condition that It is also a disability. His lawyers believe it is the first lawsuit of its kind filed in the country.
“This type of discrimination is not new; rather, it stems from a long history of prejudice, exclusion, and stigmatization of people with disabilities in general and people diagnosed with obesity, in particular,” the lawsuit says.
Jamie Whittemore of Yarmouth is suing Cigna Health in federal court for denying coverage of a weight-loss drug her doctor prescribed to treat obesity. The lawsuit contends that it is illegal to discriminate based on a medical condition that is also a disability. Shawn Patrick Ouellette/Staff Photographer
Whittemore is the only named plaintiff, although the lawsuit has also been filed on behalf of other people who have been denied coverage. It’s unclear how many patients could ultimately be affected by the case, but the lawsuit could have a broad impact on the health insurance market.
Whittemore works for the University of Maine System and has a Cigna insurance plan. In an interview Tuesday, he said that obesity is something he has struggled with his entire life.
In February 2023, Whittemore said he was prescribed Ozempic, which was covered by his insurance at the time. But then, in August, he was notified that his plan would no longer cover his prescription medications.
More recently, Whittemore was prescribed a different medication, Zepbound, for the treatment of obesity, but his insurance also denied him coverage for that medication. She attempted to appeal the decision but said she received no response.
Whittemore, 29, said he can’t afford to pay for the medication out of pocket and that even with the manufacturer’s coupon the cost would be more than $900 a month.
He said he could have bariatric surgery, but he’s worried about what that would entail and that it could be too invasive. When she was taking Ozempic, she was working and had minimal side effects.
“I know my health was on a positive trajectory when I was on that medication,” he said.
I was losing weight. She was sleeping better. And he was able to take long, pleasant walks with his dog, Nelson.
“It’s incredibly frustrating to now be in the position where I know I can’t access this medication because of the obesity diagnosis and the negative stigma that comes with it,” she said.
Whittemore and her attorneys say the ACA requires that insurance plans cannot discriminate against people on the basis of disability.
Jeffrey Young, an attorney with Solidarity Law of Cumberland Foreside, represents Whittemore and said obesity is considered a disability and medications to treat it should be covered.
Cigna offers plans that cover drugs and plans that don’t, but Young said all plans must include coverage for drugs, based on patient protections in the ACA.
He believes the lawsuit is the first of its kind in the country.
THE FIRST OF ITS KIND
“Cigna’s exclusion of medications to treat obesity is discrimination, plain and simple,” Eleanor Hamburger, a Seattle attorney who also represents Whittemore, said in a written statement. “Other Cigna members can access the prescription drug coverage they need, while members who are diagnosed with obesity do not have coverage for proven, medically effective treatment for their disability. Different treatment based on disability is illegal.”
Zepbound and Ozempic belong to a group of medications that have been prescribed to treat diabetes and are now very popular weight loss medications prescribed to treat obesity.
Zepbound is a weekly injection that can cost more than $1,000 a month for patients who pay out of pocket. It is generally covered for use in diabetes management, but many insurance plans do not cover it for weight loss.
Cigna did not respond Tuesday afternoon to a request for a response to the lawsuit.
Insurance coverage of increasingly popular weight loss drugs and rapidly rising costs have been a concern in the insurance industry and among employers, who determine what coverage to include in plans offered to their workers. The new federal lawsuit focuses on the insurance company, arguing that it cannot legally offer plans that discriminate.
Cigna Group said in March it was launching a program to limit cost increases for new weight-loss drugs to 15% annually in an effort to give private employers some predictability of future costs and ultimately make that weight loss treatments are more accessible in coverage. plans.
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