The State Employee Benefits Committee wants more information about weight loss drugs and whether others are paying for them before approving them for employee and retiree coverage.
NOTE:This story has been updated to say Sussex County government has no knowledge about any efforts to assure Medicare patients there can have weight loss drugs when others cannot and that county government has no control over what is in individual medical plans.
The State Employee Benefits Committee wants more information about new weight loss drugs that are helping people across the world shed pounds, as well as more information about who else is covering them.
The committee must approve the drugs’ inclusion before insurance plans for state employees and retirees pay for them.
Employees and retirees have been calling and writing to the benefits office to ask for the drugs to be covered, said Jaclyn Iglesias of Willis Towers Watson.
The drugs would cost the program about $8,000 to $9,000 a year per person who used it, after rebates from manufacturers are included, she said.
While the drugs are less expensive than bariatric surgery, they are likely to be ongoing costs, she said, that ultimately will cost the state an additional $1.8 million to $2.9 million a year, depending on whether the drugs included management.
Cerron Cade
That would mean that state health insurance premiums would need to rise to cover the costs, she said.
The committee already is considering raising premiums because of a projected deficit of $138 million by the end of the 2024 fiscal year.
“We’re not necessarily recommending moving forward with offering coverage at least in the short term,” Iglesias said. “Recognizing that there’s a greater deficit to solve, this additional cost of drugs doesn’t necessarily help in the short run.”
Others weren’t sure.
Committee member Cerron Cade, who also is the director of the Office of Management and Budget, said he didn’t want to block access for state employees and retirees if Medicaid and Medicare already approve it. Medicaid does, the committee was told, but Medicare does not.
Trinidad Navarro, a committee member and Delaware Insurance Commissioner, said many in his office favored approving the drug.
He pointed out that they do lower blood sugar, weight and cholesterol and for diabetics, that means less damage to their kidneys, eyes, hearts and other organs that are hurt by high blood pressure.
But, he said, there also have been no 10-year studies of the drugs. Most health officials consider 5- and 10-year studies to be critical to confirming a drug’s effectiveness and teasing out side effects.
Navarro said he was in favor of studying the drugs more, but also believes it is possible that they could have great benefits down the line by saving the state money it now spends because of the widespread bodily damage caused by diabetes.
Cade wanted to know what New Jerson bases its approval on, and Iglesias said she would find out more about it and report back in March.
Callers support weight loss drugs
Several people who called in during the meeting’s public comment session urged the state to approve the drugs.
Teresa Craig said she has not been able to lose weight since her thyroid was removed because of cancer, and she’s been turned down for bariatric surgery because she has a hormonal issue, not an eating problem.
“I really hope that you guys really consider this because I think that it will change a lot of your employees’ and your pensioners’ and spouses’ and dependents’ lives in a good way,” she said.
Deldra Gregory-Colvin, the benefits coordinator of Colonial School District, said she had been on the state’s diabetes prevention program and had lost 15 pounds.
It wasn’t enough, and her doctor recommended she try a weight loss drug, she said.
Gregory-Colvin said she understood the medicine was expensive and the committee had to contend with a deficit.
“My ultimate request is that the weight loss medication be fully covered under a prescription,” she said.
At a minimum, she suggested the state remove it from the excluded list, which then allows an insurance company to review the patient request and those who need the drugs to get them.
That arrangement would allow the state to slowly open to the medication and allow it to do its own research on how well it works.
It also would signal to employees that the state takes obesity seriously and acknowledge that it’s a disease and the root causes of many other diseases, Gregory-Colvin said.
Kelly Kline, a state employee, said diabetes runs in her family. She wants to be able to give the drug to her son, she said, and help him avoid it.
LeVar Johnson, a regional rep for Novo Nordisk, which makes Wagovy and Saxenda, said Sussex County is working on a waiver that would allow Medicare recipients who live there to receive the drug.
“I don’t think we need a whole lot of clinical evidence to know that if someone was to reduce their body weight even by the measure of 5%, what comorbidities attached to obesity will decline,” he said in urging the state to pay for the drugs.
However, Chip Guy, communications director for Sussex County government, said that was not true and county officials did not know who Johnson was.
“To be clear, County government has no jurisdiction over the federally administered Medicare program,” Guy said, “and there is no effort by the County (nor would it have any say) in terms of exempting residents on the specifics of their healthcare coverage.”
The weight loss drugs,Ā a relatively new classification of gucagon-like peptide-1s receptor agonists (GLP-1s) contain the active compound semaglutidem, which mimics a hormone and seems to suppress appetite.
Most users inject the drugs into their stomach once a week and those without insurance pay about $1,000 out of pocket, although some manufacturer coupons can cut the cost for one to a few injections.
Brand names include Wagovy, Ā Saxenda, Trulicity and Ozempic. Trulicity and Ozempic originally were prescribed for diabetics to help them reduce their blood sugars.
Then others discovered the way they curbed appetites and helped people lose weight, and doctors started prescribing them off-label to people who simply wanted to drop pounds.
They were so popular that for a while at the end of 2020 diabetics had a hard time getting their prescriptions filled.
Users say they often feel nauseated the day they take the shot and some report vomiting, diarrhea and stomach pain but by the next day, they simply aren’t hungry and food is not appealing.
There are few long-term studies of the effects of the drugs and recent stories have warned that they could also cause thyroid tumors and cancer, among other issues.
Novo Nordisk, the maker of Wagovy and Saxenda, spoke to a benefits subcommittee about the benefits of the drugs.
The company’s Paul Dempsey was back to comment Monday.
“You look at the state’s top seven chronic conditions, lower back pain, depression, osteoarthritis, hypertension, Type 2 diabetes, cardio and coronary artery disease and asthma, and they’re increasing year over year,” he said. “They are key drivers. They’re all obesity related.”
