Maine woman sues Anthem insurance for not covering weight loss drugs

A Maine woman has filed a lawsuit against the parent company of Anthem Insurance for refusing to cover weight loss and obesity medications.

It is the second lawsuit filed in Maine this year against insurance companies for denying claims for weight-loss drugs. The first lawsuit, filed against Cigna in June, was one of the first of its kind in the country. A similar lawsuit was filed in Washington state in late 2023, according to media reports.

The most recent Maine lawsuit was filed on Sept. 20 by Rebecca Holland in U.S. District Court in Portland against Elevance Health. Elevance is the parent company of Anthem, Maine's largest insurance carrier.

The lawsuit alleges that Anthem's “obesity exclusion” prevents patients like Holland from accessing drugs like Ozempic, Wegovy and Zepbound because Anthem does not cover the cost of weight loss.

The drugs work by suppressing a person's appetite.

Zepbound and Ozempic belong to a group of medicines that were prescribed to treat diabetes and are now extremely popular medications for weight loss and obesity treatment.

Zepbound, for example, is a weekly injection that can cost patients more than $1,000 a month if they pay for it out of pocket. Diabetes treatment is usually covered by insurance, but weight loss is not.

Coverage for increasingly popular weight loss drugs and rapidly rising costs are causing concern for the insurance industry and employers as they decide what coverage to include in plans for their employees.

The new Maine lawsuit says Anthem's plan does not cover the cost of patients' medications, even when deemed “medically necessary,” and argues that restricting obesity treatment will be more expensive in the long run because of the health risks associated with it.

According to the lawsuit, the “obesity exclusion is irrational, arbitrary, and likely more expensive than covering prescription obesity drugs. The longer Anthem continues to craft and administer the obesity exclusion, the more it puts the health and lives of its insureds diagnosed with obesity at risk due to the many symptoms and comorbidities associated with obesity.”

Holland, the lawsuit says, is enrolled in an Anthem plan through her employer, Falmouth Schools, and “was discriminated against by Anthem on the basis of disability because she has been diagnosed with obesity, a (disabling) health condition, and requires treatment with medically necessary prescription medications for that health condition.”

According to the lawsuit, obesity exclusions in insurance policies violate the Affordable Care Act, which protects people with disabilities, including those with obesity.

“This type of discrimination is nothing new; rather, it is the result of a long history of prejudice, exclusion and stigmatization against people with disabilities in general and people diagnosed with obesity in particular,” the lawsuit states.

Shelby Leighton, Holland's Washington-based attorney, declined a Press Herald request for an interview with Holland. Stephanie DuBois, a spokeswoman for Anthem, also declined an interview request, saying that Anthem does not comment on pending litigation.

Holland suffers from “sleep apnea, numerous foot, shoulder and other musculoskeletal injuries that require physical therapy and temporarily limit her ability to walk and stand, and high cholesterol – all a result of her obesity,” the lawsuit states.

She paid for the drugs out of her own pocket at times. Although the lawsuit did not specify how much Holland paid out of pocket, these weight-loss drugs can cost $1,000 or more per month without insurance.

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