West Virginia’s Public Employee Insurance Agency (PEIA) is in a bind. Medical inflation continues to drive up health care costs and the PEIA finance board is looking for ways to save money while holding down increased costs to thousands of state and local government employees.
One of the places PEIA has found savings was in the elimination of a pilot weight-loss program utilizing GLP1 medications like Ozempic and Wegovy. That saved about $1.3 million a month, but it also left about 1,000 participants without the medication necessary to continue the program.
Dr. Laura Davisson, director of Weight Loss Management at WVU, administered the pilot program for about 500 individuals, and she was disappointed by the decision to end it. She called the results remarkable. “Patients lost an average of 15 percent of their body weight and improved key health markers like blood pressure, cholesterol, and hemoglobin A1C.”
Davisson is arguing for reinstatement of the program to better determine the long-term results. If GLP1s, combined with nutrition counseling, exercise guidance and frequent follow-ups, can lead to healthier individuals, then overall health care costs might decline. “I suspect we will learn that GLP1s could be part of the solution to PEIA’s problems,” she said.
President Biden and policy makers in Washington are trying to expand access to these expensive and effective weight loss drugs.
Senator Shelley Moore Capito and West Virginia 1st District Representative Carol Miller are cosponsoring the Treat and Reduce Obesity Act which would require Medicare to pay for anti-obesity drugs and behavior therapy treatments. It has passed out of a House committee.
Meanwhile, the Biden administration is trying to accomplish the same goal, but without going through Congress. The Centers for Medicare and Medicaid Services are proposing a new rule requiring those health services to cover weight-loss drugs.
That proposal may constitute a federal overreach, and it will attract budget hawks since it will cost the federal government another $40 billion over ten years, while states would pay nearly $4 billion for their Medicaid share.
Still, when West Virginia Governor and Senator-elect Jim Justice was asked about the proposal, he seemed to support it. “I would be a proponent of trying to do everything we can to be able to expand these drugs that you are talking about to everybody,” Justice said. “Because at the end of the day it will save us money.”
Justice has first-hand experience. He confided during the briefing that he takes Ozempic, a GLP1 used to treat diabetes and for weight loss. Justice said he’s lost between 30 and 50 pounds. Justice can afford the drugs, which can cost $1,000 or more for a one-month supply.
That is out of the reach of most West Virginians, and a significant cost driver for PEIA. Twenty percent of the drug costs for PEIA last year, or about $53 million, were for GLP1s to treat diabetes.
Centers for Disease Control data show that in 23 states, more than one in three adults has obesity, and the adult obesity rate in West Virginia is 40 percent. It is not enough to suggest that people need to eat less or exercise more. That’s been the message for years and we continue to get heavier and sicker.
Anti-obesity drugs are a valuable tool that, when combined with lifestyle changes, can lead to a healthier population and hopefully health care cost savings. Who knows what will happen in Washington, but West Virginia should resume investing in the PEIA weight loss pilot program to quantify the potential benefits.