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A MedPage Today opinion article by Pakistani American physician Hamayle Saeed describes a mismatch between diabetes screening guidance for Asian Americans and BMI thresholds commonly used to determine GLP-1 coverage. The account is not an announcement of a policy change; it raises questions about how clinical guidance, drug labels and insurer authorization rules apply to Asian patients.
A Pakistani American physician says she was screened for diabetes once her body mass index reached 23, but was denied a GLP-1 medication at a BMI of 26.5 because she did not meet the usual eligibility criteria described in her account. In an October 31 MedPage Today opinion article, Hamayle Saeed argues the contrast reflects a gap between diabetes guidance for Asian Americans and coverage rules that often rely on higher BMI cutoffs.
Saeed writes that her clinician began diabetes screening in line with American Diabetes Association guidance for Asian Americans, who can face elevated diabetes risk at lower BMI. But she says she was not eligible for a GLP-1 prescribed for weight management: the criteria she describes generally start at a BMI of 30, or 27 with a weight-related condition. She says she had no diabetes and did not meet either threshold.
The article distinguishes clinical screening from access to medication. A screening threshold is a prompt to check for disease; it does not itself establish a diagnosis or guarantee treatment or insurance coverage. Saeed’s central point is that the same BMI can trigger earlier screening while failing to satisfy an insurer’s authorization rule.
She also points to changing public coverage. According to the article, Medi-Cal ended coverage for GLP-1s for weight loss in January, and MassHealth followed in July. The report does not provide a full accounting of current private-plan rules or exceptions, and coverage can differ among plans.
Screening Rules and Drug Access
The disparity matters because screening and treatment access can be governed by different standards. If clinicians are advised to look for diabetes risk at a lower BMI in some populations, but medication access is tied to BMI cutoffs derived from other populations, patients may encounter a mismatch between risk recognition and available treatment.
Saeed cites evidence that Asian populations can have different body composition and diabetes risk at a given BMI. She reports that a study of nearly 1.5 million adults in England found South Asian adults reached a diabetes risk comparable to white adults at BMI 30 at a BMI of 23.9; for Chinese adults, the reported BMI was 26.9. Those findings describe risk comparisons in that study, not an individual diagnosis or a prescription decision.
Her argument also concerns how coverage decisions are made as public programs reduce benefits. When plans use uniform thresholds, patients who do not fit those thresholds may face barriers even when a clinician sees a reason for further evaluation. The article does not establish how many patients are affected or whether insurers will revise their rules.
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How BMI Cutoffs Diverge
Saeed says the World Health Organization set lower BMI action points of 23 and 27.5 for Asian populations in 2004. She also cites the ADA’s 2026 Standards of Care, which she says instruct clinicians to confirm excess adiposity using cutoffs appropriate to ethnicity and specifically refer to South Asian patients. These are clinical guidance points; they are not necessarily the criteria used by every health plan.
The article argues that GLP-1 eligibility has remained tied to older trial and payer conventions. Saeed cites a 2026 analysis of 352 GLP-1 trials in which BMI criteria were reported to exclude a larger share of Asian adults than non-Asian adults. She also describes the 2025 STEP 11 study in South Korea and Thailand, which enrolled participants under a local obesity definition of BMI 25 or higher. The article reports average weight loss of 16% with semaglutide and 3.1% with placebo; a smaller post hoc subgroup below BMI 30 also showed weight loss in both study arms.
Saeed says current U.S. product labels for Wegovy and Zepbound describe eligible patients using obesity or overweight plus a weight-related condition, without specifying a BMI number in the indication. However, she says the 30 and 27 thresholds remain in trial descriptions and payer authorization forms. The article’s focus is the difference between label language and how plans operationalize eligibility.
“The ADA guideline that flags me for annual diabetes screening and the prior authorization form that denies me the drug are describing the same 26.5.”
— Hamayle Saeed, MD, in a MedPage Today opinion article
Coverage Rules Still Vary
The opinion article does not identify the insurer involved in Saeed’s denial or provide the wording of its authorization policy. It is also unclear whether her clinician sought an exception, whether an appeal was filed, or what outcome followed. Her personal account cannot establish how often similar denials occur.
The article discusses label language, trial enrollment and payer forms, but does not provide a comprehensive review of every current U.S. plan’s rules. The relationship between FDA-approved indications, clinical guidelines and insurance coverage depends on the specific medication, indication and plan. The cited studies also do not by themselves establish that lowering a coverage threshold would be appropriate for every patient or payer.
Whether Payers Change Criteria
The immediate issue raised by Saeed is whether insurers and public programs will align authorization rules with the ethnicity-sensitive BMI guidance she cites. The article reports no announced federal, state or insurer policy change in response to her account. Readers seeking coverage should check the current criteria for their own plan and discuss individual risks and treatment options with a clinician.
Further developments would include changes to payer forms, public-program benefits, or guidance from clinical organizations. Until such changes are documented, the extent of the mismatch—and whether patients can obtain exceptions through appeals—remains plan-specific.
Key Questions
What happened in the report?
Pakistani American physician Hamayle Saeed wrote that she was screened for diabetes at a BMI of 23 but was denied a GLP-1 for weight management at BMI 26.5 because she did not meet the criteria described in her account.
Does a BMI of 23 mean someone has diabetes?
No. A BMI threshold can prompt screening; it does not diagnose diabetes. Diagnosis requires appropriate clinical testing and evaluation.
Why does the article focus on Asian patients?
Saeed says Asian populations can face diabetes risk at lower BMI levels, and cites guidance and studies using population-specific thresholds. Risk varies among individuals and communities.
Are GLP-1s covered for everyone with a BMI below 30?
No. Coverage depends on the drug, its prescribed use, the patient’s health profile and the insurer or public program. Saeed describes criteria of BMI 30, or 27 with a weight-related condition, but rules may differ by plan.
Has a policy change been announced?
The opinion article reports no new policy change prompted by Saeed’s experience. It describes a gap between clinical guidance and authorization practices, while noting that coverage rules vary.
Source: medpagetoday.com
