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Posted 7/5/2022

Prepared by Christopher Gallagher, OCC Washington Representative

Support for TROA Continues to Grow

At the time of this report, the Treat and Reduce Obesity Act had reached 167 total House and Senate cosponsors with the addition of Representatives Hank Johnson (D-GA) and Jamaal Bowman (D-NY). OCAN members continue to meet with members of Congress and are hopeful that more legislators will cosponsor TROA — especially in the wake of recent guidance from the Federal Office of Personnel Management (OPM) spelled out specific guidance for health insurance carriers that administer Federal Employee Health Benefit (FEHB) plans. In that guidance, OPM clarified “that FEHB Carriers are not allowed to exclude anti-obesity medications from coverage based on a benefit exclusion or a carve out”… and that "FEHB Carriers must have adequate coverage of FDA approved anti-obesity medications (AOMs) on the formulary to meet patient needs and must include their exception process within their proposal.”

Wisconsin Group Insurance Board to Hold Special Hearing on AOM State Employee Coverage

At the time of this report, the State of Wisconsin’s Department of Employee Trust Funds (ETF) Group Insurance Board (GIB) will hold a special hearing on June 30th to address state employee coverage for anti-obesity medications (AOMs) for 2023. Obesity Care Continuum (OCC) member groups have been advocating before the ETF and the GIB for the past three years for the state employee plan to provide coverage for AOMs and robust medical nutrition therapy (MNT).

As part of this advocacy, OAC, TOS and OMA have joined with the ASMBS Wisconsin State Chapter and the Wisconsin Academy of Nutrition and Dietetics (WAND) have sent numerous letters to the ETF and the Board. Most recently, in a May 16th letter, OAC President Joe Nadglowski expressed the OAC’s “profound disappointment in the State of Wisconsin’s Department of Employee Trust Funds (ETF) recommendation to the Group Insurance Board (GIB) that the Board NOT provide state employee coverage for anti-obesity medications (AOMs) for 2023.”

Specifically, OAC took issue with the cost and utilization assumptions made by Segal that ETF used for their recommendation – predicting a 3% utilization rate and annual cost of $20-30 million. AOM utilization and real-world data from neighboring state employee health benefits plans, including Minnesota and Michigan, in addition to data from Wisconsin Medicaid, demonstrate that when access to AOMs is available, utilization has historically tended to remain below 1% for patients with obesity. OAC also voiced strong objections to the belief outlined in the ETF staff memo that “neither Segal nor ETF was able to determine any projected savings from these drugs at this time… and that … ETF will continue to review literature and cost-benefit analyses on weight-loss drugs as they become available to determine whether these drugs should be added in the future.”

Finally, OAC raised concern that members of the Group Insurance Board were not receiving all of the materials submitted by public stakeholders regarding this critical issue. For example, OAC highlighted that comments made by the obesity community to ETF and GIB earlier this year appear not to be in the official record as letters dated January 14, 2022 and April 15, 2022 were nowhere to be found under the “Board Correspondence” section of the agenda for the May 18th or February 16th meetings. As a result of OAC’s efforts, GIB members decided to table its final decision on AOM coverage and hold this special meeting on June 30th. See next month’s update for details of the meeting.

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