Why do Health Insurance Companies Cover Weight Loss Drugs but not Fresh Fruit and Vegetables?

Last month, Reuters reported that America’s third-largest health insurer, Aetna Inc would provide coverage for weight loss drugs sold by Vivus (Qsymia / Qnexa) and Arena Pharmaceuticals (Belviq).

WBB Securities LLC analyst Stephen Brozak commented that “this is probably the simplest business decision on Aetna’s plate in all of 2012, because to not reimburse this would have put them in the crosshairs of every single healthcare decision maker in the United States. Everyone acknowledges that we have a pandemic obesity problem, and to not be a part of a solution even if its a marginal solution, means you are part of the problem,” he added.

Hmmmm…marginal solution???

Why would Aetna choose to cover their costs of a marginal obesity solution while ignoring weight-loss / disease prevention solutions that actually work?

  • Like a diet high in fresh fruit & vegetables

Maybe it’s like my Twitter buddy @powerfulhunger said…that it’s too impractical to administer.

twitter conversation Why do Health Insurance Companies Cover Weight Loss Drugs but not Fresh Fruit and Vegetables?

But then again…maybe it isn’t.

Maybe it isn’t impractical for Aetna et al to partner with America’s  food retailers to provide an instant percentage discount on all fresh/frozen fruit and vegetables.

Let’s use an imaginary Aetna client to test my hypothesis…

  1. Aetna client walks into WalMart, Kroger, Costco, etc…
  2. Aetna client picks up prescription from pharmacy
  3. Aetna client presents Aetna insurance card to pharmacist
  4. Aetna client pays discounted price for their prescription
  5. Aetna client walks over to the WalMart, Kroger, Costco fresh/frozen produce section
  6. Aetna client loads up their cart with produce
  7. Aetna client presents Aetna insurance card to cashier
  8. Aetna client pays discounted price for their produce

Doesn’t seem that impractical to me.

But then again…what the heck do I know about HEALTH insurance?

Reference

Doug Robb is a personal trainer, a fitness blogger and author, a competitive athlete, a social media nerd and a student of nutrition and exercise science. Since 2008, Doug has brought his real-world experience online via his health & fitness blog, Health Habits.

6 Comments

  1. Brit

    March 23, 2014 at 6:04 pm

    A prescription is only for one person, while any fruits/vegetables they bought in your scenario would probably be used to feed the whole family. While that may not be an issue for you, I can see it being a big one for the insurance company.

  2. justin

    May 9, 2013 at 10:38 am

    Dagny, thanks for covering ib full detail everything I wad thinking after reading just the title. Clearly, although perhaps being a health expert, knows very little about insurance. His example provided is too far rudimentary it could never work. First of all, does the insurance provider covet all brands of fruits and vegetables or only the ones they deem as beneficial to health. Is reimbursement better or worse for small convenience stores compared to “organic markets”? What about grass fed beef? In addition, providers only pay out to what is deemed medically necessary so if blood testing is done that the doctor didn’t order then the lab or doc doesn’t get paid. With that being said, wouldn’t the patron buying groceries need to prove health insurance reimbursement by a dieticians prescription? Even then, chances are they would only acknowledge “scripts” from an RD.

    I am a medical laboratory scientist for a world class cancer center and ISSA/ACE personal trainer. And I know healthcare. This wouldn’t work.

    • Health Habits

      May 9, 2013 at 1:23 pm

      So what would work Justin?

    • Dagny Kight

      May 9, 2013 at 1:39 pm

      Glad I subscribed to this and I was updated to Justin’s reply!!

      Yes, my concern all along was that American insurance companies wouldn’t have a way to do this. Interestingly enough, not long after Doug’s post, I saw Walmart’s announcement that they’ve partnered with Humana to promote the “Great for You’ food products line with a discount that DOES include the fresh fruit and produce section.

      I think there are two factors here: First of all, when you’re WALMART you get to do whatever you want. Partner with Humana for anything and the PR for both corporations will be FANTASTIC. Second, Walmart can control everything within their own stores. They can identify the “Great for You” items, including fresh items, within their own pricing systems. Personally, I think they’re going to sell a helluva lot more low sugar ketchup than fresh tomatoes!

      I wrote an article about the Walmart “Great for You” program back in December:

      http://www.powerfulhunger.com/powerful_hunger_blog/walmart-has-whats-great-for-you/

  3. Dagny

    December 5, 2012 at 12:51 pm

    I happened to chat with the assistant manager of my regular grocery store this morning and I asked him about your idea. At first he was confused because he associates anything insurance-related with the pharmacy. But as he sorted it out, he commented that it would be rather unusual for a non-food supplier to do a food-related promotion but he figured “corporate” would go along with anything anybody wants to pay for. A grocery store uses any discount as a means of getting people in the store to buy other items while they’re there. He also pointed out that produce is one of the lower profit margin departments in the store because of high costs for transportation, shelving, maintenance, and spoilage. He’d rather sell you soda and boxed cereal marketed to adults.

    He said discount promotions are related to a package of pricing incentives across a product line but Aetna isn’t a food supplier so they’d have to pay for all promotion-related costs. He said it could get really expensive since it would be an on-going thing, the grocery store would have to integrate the discount into their own preferred customer card system to identify who gets the discount and on which items. Tracking the items would take regular maintenance to keep the database updated since produce is not branded. That would be necessary to track consumer behavior which is the REAL reason why stores have preferred customer cards. Aetna would also have to pay the store to get the customer data information to measure the effectiveness of the program.

    Aetna would have to see huge potential to shell out for the cost of such a program. They would have to see it as a significant marketing opportunity AND as a means of hopefully improving consumer health. They’d have to use the data gathered from the preferred shopper card system to analyze if the program has paid off.

    The cost of implementing such a program would no doubt get buried in the insurance premium which Americans expect to be very high anyway. My insurance premiums for the only program I qualify for would be $1100 a month if I could afford that. Under Obamacare, hopefully that would change for me. But I think in the end, this “discount” would be little more than a marketing ploy for the insurance company and the cost would be passed on to the consumer. Could be some VERY expensive apples when all is said and done.

  4. dagnykight

    December 4, 2012 at 10:52 am

    Hi Doug– Nice to meet you. I am an NASM trainer in Chicago. I have maintained a loss of 170 lbs for about seven years and work exclusively with the super obese. I am the author of the book “Powerful Hunger.”

    Your tweet struck me as the type of slogan-like sentiment that people like to agree with. It sounds good, it’s the popular thing to re-tweet and re-post.

    What you describe is not what insurance is designed to do. Prescription drug coverage is subject to extensive regulation. Medical coding and billing under insurance is vastly complex. If you’ve got a better plan in Canada, good for you. Here in the US, our President is trying to improve access to medical care for all Americans.

    What you describe probably already exists in some form among companies and organizations that offer insurance as part of member or employee benefits. It’s done as a means of improving employee productivity and reducing health-related absenteeism. An employee or member health initiative or wellness program might arrange for a discount card with a national or regional chain like Whole Foods or Mariano’s Fresh Market, similar to the preferred shoppers cards many grocery store chains offer. I am a member of organizations that offer shopper discounts as part of a package of benefits. I’ve been an employee of companies that arranged for gym membership discounts, smoking cessation programs, even weight loss incentives, etc. The limitation is that such programs only exist at corporations and organizations that are large enough to establish economically-viable corporate partnerships.