| | | | |  | | By Chelsea Cirruzzo and Ben Leonard | | | STATES MULL OBESITY DRUG COVERAGE — State health plans are grappling with whether and how to offer public employees a blockbuster class of weight-loss drugs without breaking the bank, POLITICO’s Kelly Hooper reports. In the past three years, 15 states have decided to offer the drugs, known as GLP-1s, for weight loss on their state employee health plans, creating a patchwork of access in which cops or teachers are eligible in one state but not another. Even among the states that cover the drugs, such as Ozempic and Zepbound, the eligibility criteria can differ widely. In Connecticut, state employees must enroll in a telehealth lifestyle-management program to access the drugs. Kentucky requires employees to join a weight-management program with lifestyle and nutrition counseling. Tennessee requires patients to obtain prior authorization from their doctors. Mississippi started covering weight-loss drug Wegovy in July for state employees with a risk of heart disease who are obese or overweight.
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Kelly Hooper/POLITICO | Why it matters: The jumble underscores the difficulty states face when paying for expensive new drugs, even those that have potential for long-term savings. While programs like Medicaid are state-run, the expense is shared with the federal government. But state employees and taxpayers fund state health plans. “It’s taxpayer dollars that are paying for these,” said Keith Athow, pharmacy director for Tennessee’s Group Insurance Plan. “So, we want to be sure that we’re judicious stewards of those dollars.” Tennessee’s state health plan paid $39 million last year for GLP-1s for weight loss — nearly triple what it paid in 2022. But because of the unanticipated expense, state officials are exploring options to cut costs, including changing certain criteria that patients must meet. Key context: For state health plans, covering the drugs is a gamble — it could cost millions of dollars a year, and little is known about what the drugs’ long-term side effects might be and whether covering the medication will reduce costs by improving the overall health of plan members, said David Iseminger, director of the employee and retiree benefits division in Washington state, which is exploring adding coverage of the drugs for public employees. “You might see the demand for it, but then if somebody is harmed by those side effects, there will also be the concern about, ‘Well, why did you rush for coverage, you should have protected me and your membership from these negative consequences, and how was that factored in?’” he said. “It’s really hard to balance those when it is such a new drug and there are so few studies.” WELCOME TO WEDNESDAY PULSE. Congratulations to the Team USA women’s soccer team for winning their semifinal game in the Olympics against Germany yesterday! You better believe I will be watching them compete for gold on Saturday. Send your tips, scoops and feedback to ccirruzzo@politico.com and bleonard@politico.com and follow along @ChelseaCirruzzo and @_BenLeonard_.
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In his first appearance with Vice President Kamala Harris since she chose him as her running mate, Gov. Tim Walz said Republicans should mind their own business when it comes to abortion. | Jamie Kelter Davis for POLITICO | WALZ: ‘WE ARE NOT GOING BACK’ — At a Harris campaign rally in Philadelphia, Minnesota Gov. Tim Walz described the “agony” he and his wife faced when going through multiple rounds of failed in vitro fertilization before conceiving their daughter. “It isn’t by chance that when we welcomed our daughter into the world, we named her Hope,” he said. Walz appeared alongside Vice President Kamala Harris for the first time Tuesday night as her running mate where he said reproductive health care access was personal for him after he and his wife used IVF. In introducing Walz, the Democratic presidential candidate praised his record on health care, particularly his strong support for abortion rights, with both repeating a refrain Harris has adopted in her campaign: “We are not going back.” In 2023, Walz signed a bill codifying the right to abortion in Minnesota. On Tuesday, Walz told Republicans to “mind your own damn business” when it came to abortion and said former President Donald Trump would move to ban abortion nationally. The Republican candidate has walked back earlier comments on a national abortion ban in favor of a “leave-it-to-the-states” approach. “When someone tells you who they are, believe it,” Walz said. “He said he’d ban abortion across this country.” Harris also praised Walz’s congressional record, including his vote in favor of the Affordable Care Act. If elected, “we will continue to make the Affordable Care Act stronger,” she said. Zooming out: Health care issues will be key in this year’s election, with Democrats pouncing on the Republican ticket — former President Donald Trump and Ohio Sen. JD Vance — on abortion rights and the cost of prescription drugs. Chelsea and POLITICO’s Toni Odejimi have a full rundown of Walz’s stance on health policy.
| | PARITY IN PRACTICE — As the Biden administration weighs updates to a 2008 law requiring private insurers to treat mental health care on the same terms as other care, state insurance regulators largely responsible for monitoring compliance face significant barriers, Ben reports. JoAnn Volk, a research professor, and Emma Walsh-Alker, a senior research associate, at the Georgetown University Health Policy Institute, and attorney Christina Goe interviewed regulators in 10 states about their work and found that oversight tools have “their limits.” Zooming out: The Biden administration is reviewing final mental health parity regulations that would expand insurers’ requirements under the 2008 law. The regulations have received significant backlash from insurers, who say workforce shortages are a significant obstacle to access and the proposal is unworkable. Some of the barriers identified: — Few consumers are aware of protections, and fewer file complaints. — A “close review” of potential barriers to care, like how insurers analyze claims for payment, can be difficult to pull off in annual reviews. — Exams allowing regulators to analyze how insurers process and pay claims can take significant time and resources and “only offer a retrospective look.” But they also found that adding more consumer protections into insurance laws can improve parity, including curbing prior authorization and creating standards for what is medically necessary. The states agreed that the parity law is a “strong foundation” for bolstering access to care. “At its core, the parity law doesn’t require robust coverage of behavioral health; it merely requires that coverage be no worse than coverage for other care,” they wrote. “But it targets one of the greatest challenges in providing equal access to behavioral health care by telling insurers how to cover that care.”
| | | | UPDATED BIRTH CONTROL GUIDANCE — The CDC posted updated clinical guidelines for contraceptive prescribing and use on Tuesday. The new recommendations cover a wide range of topics, including contraceptive options for people with kidney disease and guidance for new birth control methods. The new guidelines include several key changes from the last update in 2016 and incorporate more gender-inclusive language for transgender patients. For the first time, the CDC recommends lidocaine to reduce pain during IUD insertion and offers treatment options for abnormal bleeding during or after the procedure. Additionally, the guidelines counsel providers to inform patients with uteruses using testosterone that it will not prevent pregnancy as well as to recommend offering a self-administered injectable contraceptive as an option. Why it matters: The CDC said the updated advice could help facilitate better access to reproductive health care.
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