Woman with Down Syndrome wishes her insurance company would cover new weight loss drugs

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OVERLAND PARK, Kan. -- Four drugs have been approved for weight loss in recent years including one that was approved just last month. But doctors say there's a huge barrier to patients getting those drugs. Many insurers won't cover them.

Shannon Pittman wages an unfair battle with weight. Because she has Down Syndrome, her metabolism is slow. At just under five feet tall, Pittman weighs 240 pounds even though she says she exercises regularly and restricts her daily calories.

"The math is the hard part because I can't go over like a thousand," she said.

Dr. Shadrach Smith of Kansas City Internal Medicine says Pittman needs one of the newer weight loss medicines such as Contrave or Belviq that are designed for long-term use. But her insurer won't cover them for her. Dr. Smith says three-quarters of insurers don't cover the drugs.

"It's the long-term part that scares 'em. They really want something that's gonna get an immediate benefit for the patient and really more for the insurance company so they can save money right now," said Dr. Smith.

Insurers say they want better results than the five to 10 percent weight loss that the drugs provide. But Dr. Smith argues that can make a big different in patients' health over the long term.

"We see improvements in blood pressure, improvements in blood sugar, improvements in cholesterol levels." said Dr. Smith.

Pittman's mother says her daughter cannot afford to pay out of pocket for medicine that will cost $200 or more a month.

"It's not right. It's wrong. One of these drugs might be just the drug that will help her metabolism burn off this fat," said Donna Pittman.

Shannon Pittman said, "It might help me with my weight loss so I can feel a lot better."

Pittman instead takes a drug her insurer will cover. It's approved for pre-diabetes which she has. One side effect is weight loss. Her mother says it's helping, but she thinks an actual weight loss drug would help more.

FOX 4 contacted Amerigroup, the insurer that Pittman has under Medicaid in Kansas. The company says the state formulary does include a number of weight loss drugs, but prescriptions are subject to members meeting certain state-approved clinical criteria. Amerigroup says it would be happy to talk with Pittman.