Maine woman files class-action lawsuit against Cigna for denying coverage of weight-loss medication (2024)

A Yarmouth woman has 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 on Tuesday in U.S. District Court in Portland, arguing that the Affordable Care Act requires plans to cover weight loss medication for obesity and that it is illegal to discriminate based on a medical condition that also is a disability. Her attorneys believe it is the first such lawsuit filed in the country.

“This type of discrimination is not new; rather, it follows from a long history of prejudice, exclusion and stigmatization of people with disabilities in general and of people diagnosed with obesity, in particular,” the lawsuit says.

Whittemore is the only named plaintiff, although the suit also was filed on behalf of others who have been denied coverage. It’s not clear how many patients might ultimately be affected by the case, but the suit could potentially have broad impact in the health insurance marketplace.

Whittemore works for the University of Maine System and has a Cigna insurance plan. In an interview Tuesday, she said obesity is something she has struggled with her whole life.

In February 2023, Whittemore said she was prescribed Ozempic, which was covered by her insurance at the time. But then she was notified in August that her prescription would no longer be covered by her plan.

More recently, Whittemore was prescribed a different medication, Zepbound, for treatment of obesity, but her insurance also denied coverage of that drug. She attempted to appeal the decision but said she heard nothing back.

Whittemore, 29, said she can’t afford to pay for the medication out-of-pocket and that even with a manufacturer’s coupon the cost would be over $900 per month.

She said she could pursue bariatric surgery, but she worries about what that would entail and that it could be very invasive. When she was taking Ozempic, it was working and she had minimal side effects.

“I know my health was on a positive trajectory when I was taking that medication,” she said.

She was losing weight. She was sleeping better. And she was able to go on nice long walks with her dog, Nelson.

“It’s incredibly frustrating to now be in the position where I know I am not able to access this medication because of the diagnosis of obesity and the negative stigma that diagnosis carries,” she said.

Whittemore and her attorneys say the ACA mandates that insurance plans can’t discriminate against people based on disability.

Jeffrey Young, an attorney with Solidarity Law of Cumberland Foreside, is representing Whittemore and said that obesity is considered a disability and medications to treat it must be covered.

Cigna offers plans that cover the medications, and plans that do not, but Young said all the plans must include coverage for the drugs, based on patient protections in the ACA.

He believes the lawsuit is the first of its kind in the nation.

FIRST OF ITS KIND

“Cigna’s exclusion of medications to treat obesity is discrimination, plain and simple,” Eleanor Hamburger, a lawyer in Seattle who also is representing Whittemore, said in a written statement. “Other Cigna enrollees can access the prescription drug coverage that they need, while enrollees who are diagnosed with obesity have no coverage for proven, medically effective treatment for their disability. Different treatment based on disability is illegal.”

Zepbound and Ozempic belong to a group of drugs that have been prescribed to treat diabetes and are now hugely 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 managing diabetes but many insurance plans do not cover it for weight loss.

Cigna did not respond Tuesday afternoon to a request for its response to the lawsuit.

Insurance coverage of the increasingly popular weight loss drugs and the rapidly rising costs have been a concern in the insurance industry and among employers, which determine what coverage to include in the plans offered to their workers. The new federal lawsuit focuses on the insurance carrier, arguing it cannot legally offer plans that discriminate.

Cigna Group said in March that it was launching a program to cap cost increases for the new weight-loss drugs at 15% a year in an effort to provide private employers with some predictability of future costs and ultimately make weight loss treatments more accessible in coverage plans.

Staff Writer Rachel Ohm contributed to this report.

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