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TRICARE to cover sleeve gastrectomy for US patients

Change in policy means greater access to bariatric surgery

The American Society for Metabolic and Bariatric Surgery has announced that TRICARE beneficiaries with severe obesity will now be covered for sleeve gastrectomy due to a policy change made in December 2015 by the healthcare program for members of the military and their families. According to the ASMBS, about 193,000 people had bariatric surgery in 2014, and sleeve gastrectomy was found to be the most common procedure, accounting for 51.7% of weight-loss operations, followed by gastric bypass (26.8%), gastric band (9.5%) and biliopancreatic diversion with duodenal switch (0.4%).

“Among the major insurers, TRICARE was essentially the last hold out on sleeve gastrectomy coverage,” said Dr John M. Morton, immediate past president, ASMBS. “The ASMBS and its partners had been meeting and providing data to TRICARE for about two-and-a-half years prior to this change. We are very pleased they have now joined nearly every other health plan in providing coverage for what has become the most common bariatric procedure in America.”

John Morton

In addition to covering sleeve gastrectomy, TRICARE also updated its policy to include coverage of biliopancreatic diversion and biliopancreatic diversion with duodenal switch for individuals with a BMI≥50. Coverage of these procedures is retroactive as of September 2014.

In 2013, the ASMBS, along with the American Association of Clinical Endocrinologists (AACE) and The Obesity Society (TOS), updated its clinical practice guidelines to include laparoscopic sleeve gastrectomy as a primary bariatric and metabolic procedure. That same year the Centers for Medicaid and Medicare Services (CMS) began routinely covering the procedure nationwide and insurers throughout the country soon followed suit.

Wayne English

“Bariatric surgery remains the most effective method of weight loss and sleeve gastrectomy is an important option that should not be excluded because it’s among the newer procedures,” said Dr Wayne English, Chair of the ASMBS’ Access to Care Committee. “TRICARE did the right thing and we as a society and health professionals will continue to work very hard so that our patients have access to life changing, and in many cases, life-saving procedures. Insurers cannot afford to not cover bariatric surgery.”

Drs Morton, Wayne English, Chair and Co-Chairs John Scott and Brandon Williams, of the Access to Care Committee led ASMBS efforts with TRICARE.

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American Society for Metabolic and Bariatric Surgery

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