PEIA says cost for weight loss drugs is crushing, but people also want and need access

Officials with West Virginia’s insurance program for public employees are considering how to strike a balance between the demand for weight loss drugs and the significant cost.

A meeting of the Public Employees Insurance Agency on Thursday afternoon returned to the question a couple of times in a broader discussion of financial pressures. Separately, a New York Times article this week highlighted that difficult balance, spotlighting West Virginia among states struggling to meet the challenge.

The national article noted that in March, PEIA canceled a pilot program to cover weight-loss drugs. The cost was mounting, even though the program was limited to about 1,000 people — adding up to about $1.3 million a month. Brian Cunningham, PEIA’s director, told the Times that if the program were expanded to include up to 10,000 people as intended, the program could end up costing $150 million a year.

The drugs like Wegovy and Zepbound may be used to treat obesity or diabetes — or both — but some insurers including most Medicaid programs only cover them when they are used to manage diabetes. The question for states as they try to balance public interest is how much to expand access for weight loss.

Discussion was  blunt during the PEIA meeting, where Finance Board members discussed a range of reasons for rising costs just as the fiscal year reaches its conclusion. Overall, PEIA’s expenses are $45 million beyond what the agency had anticipated, and that has driven an overall deficit of $35 million so far this fiscal year.

PEIA Finance Board members asked how much of that is due to the cost of drugs for weight loss and diabetes.

Brian Cunningham

“Let me throw out just one number, if I may: $84 million,” Cunningham said — then repeating the number: “$84 million. That’s the spend on GLP-1s through May of this plan year, 11 months of the year. It’s a combination of both drugs used for weight loss and drugs used for diabetes.”

GLP-1 stands for glucagon-like peptide receptor agents — a class of medications that treat Type 2 diabetes and obesity. The well-known Ozempic drug is a GLP-1. So is Wegovy.

Other national news articles have focused on the high cost of these drugs — and the financial bind for governmental or private insurance plans in covering them. An article for NBC News, like this week’s New York Times piece, cautioned “Weight loss drugs Wegovy and Zepbound remain out of reach for many who need them.” Axios reported, States clamping down on coverage of weight-loss drugs.

“How do we come up with a more permanent or long-term strategy around weight loss? ” asked Doug Coffman, a PEIA board member from Harrison County who represents hospitals. “I mean, this is not a problem just for West Virginia, and it’s not just state government. It’s commercial, and it’s all health plans that I’ve experienced. I think coming up with a strategy that is compassionate to our enrollees and protect us a little bit more financially is desperately needed.”

Cunningham, the PEIA director, said he agrees.

“As it relates to GLP-1s across the board, we are working to put that strategy in place. We have to bend that curve.”

He continued, “Now, again, those GLP-1s, they have a lot of uses. Some are labeled for weight loss. I agree that a compassionate strategy is needed, and all options are on the table there, as well.”

Laura Davisson

Laura Davisson, the director of the weight management program at the West Virginia University Health System, said she agrees with the need to for a long-term strategy to address obesity. She said she is willing to provide expertise as an obesity medicine specialist to PEIA and other healthcare organizations in the state so we can treat the problem of obesity in an appropriate and cost-effective way.

“These medications are expensive, but that doesn’t mean we shouldn’t use them here in West Virginia, where we lead the nation in obesity,” she said via email in response to the discussion at the PEIA meeting. “We need to include every tool in the toolbox in a comprehensive obesity treatment strategy. “To manage costs and get the most benefit, we need to get the right treatment to the right patients, whether that includes lifestyle changes, medications, or surgery.

Davisson said she has worked with PEIA on the pilot of using anti-obesity medications in a small number of patients “and we got incredible results. Unfortunately, the money PEIA invested in these patients is going to be wasted when these patients all get their medical treatments stopped regardless of where they are with their treatment.”

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