Frequently Asked Questions
What is the genesis of the Obesity Coverage Nexus?
The Obesity Coverage Nexus Platform was funded by the Robert Wood Johnson Foundation to provide insight into the current state of health insurance coverage for obesity treatments and to provide researchers, policy makers, patient advocates and others with a rich source of data and information to explore issues of health, racial and economic equity.
The publicly accessible interactive platform makes some of the key findings available broadly to the general public.
In addition, the more granular and detailed information will be made available to researchers, state and federal policy makers, patient advocacy organizations, and media through a limited number of non-commercial use licenses funded by RWJF.
Where is the source information coming from to support this platform?
The source data and information come from a variety of publicly accessible places and vary in format and structure.
What are the types of sources used to support this platform?
There are varied types of Federal, State and Other Entity level sources used to support this platform. These include:
- STATE DEPARTMENT OF INSURANCE
- STATE DEPARTMENT OF HEALTH
- STATE AUDITORS’ OFFICE
- STATE LEGISLATURE
- STATE MEDICAID AGENCY
- STATE DEPARTMENT OF ADMINISTRATION
- U.S. OFFICE OF PERSONNEL MANAGEMENT
- U.S. HEALTH AND HUMAN SERVICES: CMS
- U.S. CENSUS BUREAU
- U.S. DEPARTMENT OF LABOR: BLS, EBSA
- U.S. SECURITIES AND EXCHANGE COMISSION
- SERFF AND NAIC
- PAYOR SITES – INSURANCE CARRIERS, EMPLOYERS
How were you able to put together the market segmentation that fuels the visual controller?
LEVERAGE developed an Integrated Mapping Framework (IMF) of sources on how people get their health insurance coverage across markets and payors with the latest quarterly information available at both state and federal level.
How current is the data and information reflected on the platform?
All access and coverage data and information are reflective of 2024 (baseline year).
How frequently is the information and intel on the Obesity Coverage Nexus platform updated?
Information and intel updates to the platform occur every 8-10 weeks, based on release schedules. Since obesity medication coverage is quickly evolving, we may update coverage data more frequently as needed.
When and how was the information reflected on the platform derived?
The LEVERAGE team conducted an extensive, manual review of the source information available. Access and coverage attributes and values were established and extracted using the capabilities built into AXIACI. Access and coverage derivations are based on our best assessment of information contained in multiple source objects. We continually work to ensure the timeliness and accuracy of the access and coverage insights provided. However, payer policies change frequently and may not be reflected immediately in AXIACI.
How can I access, validate, and/or review the details of the information extracted for the Obesity Coverage Nexus?
Detailed data and information on coverage will be available through a limited number of non-commercial use licenses funded by RWJF. Users will have access to the obesity data and source information through the AXIACI interactive data and information platform and will be able to use the capabilities to create their own additional attributes.
Would I be able to establish and derive my own information on this platform?
The AXIACI Non-Commercial Terminal Platform provides the capabilities to establish, derive and analyze your own information and intel.
Where do I request an RWJF-sponsored non-commercial user license?
Please click or on “REQUEST ACCESS” above to submit a request for a license.
Do you also have other offerings for non-commercial and commercial use?
Yes, we do. Coverage and access information for other services and drugs are available. Please click or on “CONNECT” above or call us at 1 (401) 788-5374 to discuss other offerings.
Questions From the Webinar
How do you verify coverage? A lot of patients will “have coverage” according to an eligibility verification, but then will get denied when prescribed. Thanks!
The first set of visuals addresses how many people have plans that cover the drugs or surgery; the other four visuals outline the criteria an individual must meet in order to have the drug or surgery paid for by the plan.
Is this just for adults? Any information on children/adolescents?
It does include those under 18. The public platform does not specifically address the requirements for those under 18 but this could be addded in the near future
Is it possible to filter down to specific plan? Like Anthem BCBS PPO in VA and then use this tool to determine if a patient with this insurance will have coverage for a specific type of care, and what requirements may be in place?
Yes, we can. If the request is specific to obesity, please go to the home page of the Obesity Coverage Nexus, scroll down and click on "RWJF User License."
If the request is about coverage and coverage criteria for other drugs and/or services, please click on "Connect" on the home page to request information on commercial and non-commercial use licenses.
Do we need to request access to get the visuals to appear? I’m on the dashboard right now and can’t get the visuals to appear (i.e. the map, and the pie charts)? Thanks - this is a wonderful resource!
The visuals should be appearing. If they are not, make sure you have clicked into the platform; you may need to scroll down a little on the landing page to see the link.
Could you please also talk about the process for researchers to license the more granular version of the underlying data for non-commercial use (research purposes)?
Please go to the home page of Obesity Coverage Nexus, scroll down and click on "RWJF User License."
What are the negative impacts that might occur if the talks of grandfathering obesity coverage through Medicare comes to light? There are talks that representatives will only suggest coverage for people already receiving obesity coverage before 65.
Stay tuned for more in-depth discussions/blogs/interviews/commentary!
This is a super resource for employer plan sponsors like my state EE plan. I can see how it can be used in other areas, i.e. behavioral health. Is expansion to other areas of care contemplated for this platform?
The underlying AXIACI platform does have information and data on other areas as well. Please click on "Connect" on the home page to discuss in more detail.
Is plan- or employer-level data available? Either in the public or licensed version?
Yes. It is in the licensed platform
Commercial insurers could increase BMI to limit coverage, but Medicaid/Medicare would need to stick to the FDA label, correct?
In some states, the Medicaid program requirements exceed the label requirements. We will be updating the platform to include Medicare Advantage plans' coverage criteria as it becomes available.
Did your work also look into what coverage looks like once started on medication treatement? Are plans addressing the continued need for lifestyle modication?
Yes. Most include a requirement of documentation of continued lifestyle modification as a criteria for continuation approval
How are you looking at cost effectiveness? Are you looking at a 20-year time horizon?
Not in this iteration of the Obesity Coverage Nexus -- a great next project, perhaps!
Those having had BS are getting drugs at one year and this is creating even greater costs.
Some payers have criteria that exclude coverage for some period of time, as well as additional restrictions, after bariatric surgery has been performed