GLP-1s have proven to be effective in weight loss, but the nation is grappling with shortages and high costs of the drugs. So who should be making the call on which patients get access to the drugs?
According to Dr. Timothy Law, chief medical officer of Highmark, physicians should be the decision-makers, and insurers should be “conduits to care, not roadblocks.”
“We need to get out of the way of the physician and let them do their job. … [Physicians] who are seeing patients on a regular basis need to be the ones that do the so-called rationing, of making sure that your sickest people get on the medicines or the people who need it the most get on the medicines,” Law said during a Wednesday panel discussion at the AHIP 2024 conference held in Las Vegas.
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However, he said he worries that the responsibility of rationing will be put on insurers so they can be seen as the “bad guys.”
Dr. Melanie Jay, director of NYU Langone Comprehensive Program on Obesity Research, pushed back on the idea of making individual providers decide who gets GLP-1s.
“Individual doctors are not a public health solution because they work within a system,” Jay said on the panel. “We don’t want every individual making different decisions because that’s the way health equity dies, that people who don’t have access to care don’t get it.”
Law noted that in a perfect world, it wouldn’t be the physician or the plan making the decision and that there needs to be more pressure on pharma to improve the supply of GLP-1s.
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“Why is nobody pushing back on that community to say, ‘Hey, manufacture more.’ We did it for masks for Covid. … Whose responsibility is it to make more? Well, it’s not mine. I can’t judge that, the doctor can’t judge that,” he said in an interview.
The price of the drugs also needs to be questioned, Law added. A recent study showed that Ozempic can be manufactured for less than $5 a month despite its list price being about $1,000 per month.
The challenges that come with GLP-1s have insurers reexamining their policies. On Wednesday, Bloomberg reported that Blue Cross Blue Shield of Michigan will stop covering GLP-1 obesity drugs in fully insured large-group commercial plans beginning in January.
Law said that Highmark is continuing to evaluate its coverage of GLP-1s, but doesn’t see itself completely dropping coverage. He noted that Highmark’s self-insured employer plans make their own decisions on coverage of GLP-1s. For Highmark’s fully insured plans, he’s considering a tiered approach but hasn’t made a set decision.
“It’s up to the person paying the money,” he told MedCity News. “I’m not sure how Michigan is doing it, but what many companies will do is take the benefit out of the fully insured and then talk to the groups and say, ‘If you want to add it in, this will be your new premium. If you don’t, you can keep your premium.’ Then it puts the onus of that decision of whether or not to offer obesity coverage back in the hands of the people.”
Photo: Jason Dean, Getty Images
