Should ACA plans cover weight loss drugs?

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Should ACA plans cover weight loss drugs?

Drug makers are doing everything to tap the bottomless well of demand for new obesity drugs — and now, they might get some government help. CMS is considering a technical change that would require insurers to cover obesity drugs in a market of more than 20 million Americans, John Wilkerson writes.

The potential change is a small one, despite its potentially significant impact. Since Medicare can’t cover weight-loss drugs, ACA plans aren’t required to cover them either. But if the agency were to replace ACA’s drug classification system with one that is not based on Medicare, it could require plans to cover the obesity drugs as well as treatments for infertility and sexual dysfunction.

Insurers would still have tools to restrict coverage, such as formulary tiers, experts tell John. But it could open up a market that has been relatively slow to cover the roughly $16,000-a-year new class of medications. More on how it would work.

‘This could have been a [follow-up] email’

HHS’s lack of cooperation with a congressional committee investigating the Covid-19 pandemic is “unacceptable” and could prompt “compulsory” testimonies, Brad Wenstrup (R-Ohio), Chairman on pandemic oversight, said in a letter to the agency Friday.

The letter, shared first with STAT, comes roughly two weeks after a top HHS official testified before his committee, rankling Republicans who accuse the agency of withholding and delaying internal documents about Covid-19’s origins, shutdown measures and other policies.

Wenstrup listed 12 separate times the committee asked for this information and demanded details on how those requests were handled. If HHS’s answers don’t satisfy the committee, Wenstrup could resort to “compulsory” measures, he warned. More here.

Banning surprise medical bills is raising other costs

The good news first: The federal government’s surprise medical bill ban is protecting patients from giant costs. But it’s raising costs elsewhere, and insurers aren’t happy.

The Biden administration’s new progress report on the process for arbitrating disagreements between insurance companies and providers shows that in over 80% of payment disputes, the arbiter settled on an amount that was more than the median in-network rate for that service, Tara Bannow reports. In short, insurers were ordered to pay more to an out-of-network provider than they’d pay to a contracted one. Plus, the sheer volume of disputes means health officials are devoting a ton of time to the task, throwing into question how much this will save federal dollars in the long-run.

The report has prompted quick criticisms from policy analysts who have warned that the system in place would lead to unintended consequences playing out now. Dive into the issue with Tara.

Medicare Advantage hit 33 million enrollees

Roughly 33.4 million people were enrolled in a Medicare Advantage plan as the calendar flipped to 2024 — another year of steady, albeit slower, growth for the taxpayer-funded program, Bob Herman writes.

The data reinforce how America’s Medicare program continues to shift toward a more privatized version that has not saved any money for taxpayers, has been linked to inappropriate coding practices, and has restricted care for older and vulnerable patients. And even though the federal government made several changes to Medicare Advantage for 2024 — changes that were vehemently opposed by the health insurance industry — the program’s growth has not been stunted, nor did insurers dramatically slash their offerings.

But there are some caveats to the data, experts tell Bob. More on understanding the MA trends.

What we’re reading

• HHS fills key vaccine advisory panel slots, STAT
• ‘We can’t do anything’: How Catholic hospitals constrain medical care in America, KFF Health News/US Today
• Opinion: The complicated connections between weight loss drugs and mental health, STAT
• Trump privately expresses support for a 16-week abortion ban, The New York Times