Expensive weight loss medications? Connecticut has a plan
With Kelly Hooper
Popular medications — The Connecticut Employees Health Plan was on track to spend $30 million this year on a class of diabetes drugs that is growing in popularity as an effective way to lose weight.
State Comptroller Sean Scanlon, who administers the plan, decided it was untenable.
But instead of eliminating drug coverage as some other large employers have done, the state — which covers 265,000 employees, including teachers, police officers and firefighters — is trying something different. Kelly reports.
Since July, state health plan members searching for popular drugs Companies like Ozempic and weight loss firm Wegovy must first enroll in a clinical lifestyle management program called Flyte, which offers online weight management tools.
Participants can meet with providers and receive personalized care plans. Providers may prescribe a medication, which your state health plan will cover, or recommend a different course of treatment.
“I never thought about getting off drugs, but I also knew the status quo wasn’t going to work, and we had to look at other options,” Scanlon told Politico.
If successful, Connecticut’s unique plan could offer a roadmap for public and private institutions, which see their finances constrained by costly but ineffective treatment.
why does it matter: The Connecticut trial, which is showing promising early results, comes at a crucial moment for state and federal officials grappling with the costs of blockbuster treatments. Approval of such treatments could upend the treatment of millions of Americans and become some of the best-selling drugs of all time.
However: The medications are expensive, and patients may need to continue taking them indefinitely. State Medicaid administrators, public universities and state officials are just beginning to wrap their heads around who will pay them.
The University of Texas System, one of the state’s largest employers with more than 116,000 workers, dropped coverage of weight-loss drugs in September due to rising costs. The University of Michigan, which covers about 120,000 people, is working to increase copayments to help cover drug costs.
In North Carolina, the treasurer’s office estimated that spending on this class of drugs under the state’s employee health plan — which covers 750,000 people — could jump to more than $1 billion over the next six years. To control costs, the state health plan will no longer cover these costs for new members starting January 1.
Welcome to Wednesday Pulse. Is there something you’d like to include in your final spending deal? Let us know. Contact us on (email protected) or (email protected). We can keep you anonymous. Follow along @_BenLeonard_ And @ChelseaCeruso.
Today on our website pulse check podcast, Host Lauren Gardner speaks with POLITICO health care correspondent Kelly Hopper, who also explains Connecticut’s approach to covering expensive weight-loss drugs in its employee health plans by tying coverage to lifestyle programs.
On track to reach an agreement – With far less drama than earlier this year, government funding is set to run on autopilot until early 2024.
The White House and Senate Majority Leader Chuck Schumer They threw their support behind the ongoing stopgap resolution to fund the government on a temporary basis with two separate deadlines — one on January 19 and one on February 2, which would include a bill to fund the Department of Health and Human Services.
A total of 209 House Democrats joined 127 Republicans in supporting the continuing resolution, sending it to the Senate.
House Democratic leaders noted that the package contains no spending cuts or “poison pill” additions.
The move will keep government agencies open but does not prevent the 1 percent federal spending cut negotiated in the debt ceiling agreement that will take effect in April if a long-term agreement is not reached. CMS is concerned that continued dissolution could impact the agency’s operations, and the agency has implemented a partial hiring freeze.
Healthcare Corner: Health industry groups say the correction could deprive them of the opportunity to attach policy riders, such as efforts to avoid physician pay cuts going into effect next year, Politico’s Robert King reports.
“Umbrella buses happen for a reason,” Susan Dentzer, president and CEO of Physicians Groups of America, said in an interview with Politico. “It’s not as if they haven’t served an important purpose for many years.”
Some groups representing doctors tried but failed to stop the impending 3.4% cut in Medicare payments in the continuing resolution, according to four people familiar with the lobbying effort.
Lawmakers, including Rep. Dr. Larry Bookshon (R-Indiana) told Politico that the lack of omnibus could impact efforts to pay doctors. But Bucshon said lawmakers could still reauthorize it Business supportwhich addresses the opioid epidemic.
Bipartisan optimism about the drug – Top lawmakers on both sides of the House Veterans Affairs Committee’s health subcommittee want more research into the drug’s ability to treat veterans’ mental health issues.
Subcommittee chair Mariannette Miller Mix (R-Iowa) said the drug could alter care but urged caution, adding: “We’re not advocating legalization or accidental use.” Democrats and Republicans said they want to ensure abuse does not occur.
“At a time when much of Congress has become polarized and partisan, this is one area where many of us agree more needs to be done,” a senior subcommittee member said. Julia Brownlee (D-California).
Drug studies funded by outside groups are conducted at VA facilities. Dr. Carolyn Clancy, assistant undersecretary for health, told the committee that there are no legal barriers preventing the VA from funding its drug research, but layers of regulatory barriers discourage the research. She said the agency would fund studies in the future.
It’s not clear yet Clancy said whether the treatments will be curative or used for ongoing maintenance. The timeline for wider use is also unclear, she added.
Clancy also touted the agency’s trial at 60 sites using virtual reality to reduce pain-related suicides, and testing the use of positive environments to help build coping mechanisms.
WARNOCK INSULIN VOTING GOAL – Sin. Raphael Warnock He told reporters Tuesday that he is targeting a vote by the end of the year on his bill to limit the cost of out-of-pocket insulin to $35 a month in the private insurance market and the uninsured.
Senate Majority Leader Warnock said Chuck Schumer He is “focused” on the legislation, though he did not discuss how the bill might move. He added that he was awaiting the Congressional Budget Office’s outcome for the uninsured portion of the bill to research possible payments, which he said he worked with Schumer to expedite.
In a report issued Tuesday, Warnock and Sen. John Kennedy (R-La.) CBO’s estimate of $629 million over 10 years for the private insurance portion pales in comparison to the annual cost of diabetes of more than $410 billion, he said. Warnock said his and Kennedy’s offices were working with Senate staff. Jean Shaheen (D.N.H.) and Suzanne Collins (R-Maine) On a separate proposal to limit insulin costs.
The Collins-Shaheen bill would limit monthly cost-sharing for at least one type of insulin and dose to $35 or 25 percent of the list price, whichever is lower, and has additional requirements for pharmacy benefit managers.
Insulin prices are a top priority this session of Congress, affecting tens of millions of Americans with diabetes. Schumer has long been drafting a drug pricing package, but the details remain unclear.
More postpartum coverage – The Centers for Medicare and Medicaid Services on Tuesday approved Missouri’s plan to offer Medicaid coverage for a full year after pregnancy, making it the 40th state to offer such coverage.
The measure, which Missouri moved to expand this summer, means 18,000 more people will be eligible for Medicaid.
Alaska, Mississippi, Nebraska, Nevada and Texas are planning a one-year extension, and Utah and Wisconsin have proposed limited extensions of coverage, according to KFF. Arkansas, Idaho and Iowa have not moved to do so.
This option has been available since last April as a temporary initial option, but Congress made it permanent. Lawmakers hope to improve the United States’ maternal mortality rates — which lag behind other peer nations — and other maternal health outcomes.
The New York Times talks about the impact of rising care costs for the elderly.
Healthcare Dive reports on the American Medical Association’s new policies on obesity medications and opioid use disorder treatment.
POLITICO’s Josh Cisco reports on a House hearing showing GOP support for antitrust.