Asheville – The Buncombe County Commissioners spent a good hour of their last formal meeting talking about Wegovy. The county is self-insured, so, as a good steward of taxpayer dollars, it is in the interest of those elected to control costs. That’s why a closed session followed the meeting to discuss lawsuits against TeamHealth for upcoding and billing county employees up the ying-yang when visiting the emergency room and Mission Health for alleged antitrust maneuvers.
Driving the evening’s discussion was a report from USI, the consultant with which the county works for structuring health benefits. It stated that, midyear, claims were running $1.8 million, or 4.6%, overbudget. For the coming year, it was suggested that the county allocate $1.4 million toward closing the current gap and come up with a strategy for getting health plan beneficiaries to pay the balance. To do this, staff recommended increasing premiums, increasing the coinsurance rate, and/or ceasing to pay for glucagon-like peptide-1 (GLP-1) agonists that are used for weight loss instead of diabetes control. The county has spent over $495,000 on non-diabetic GLP-1 drugs for 108 employees since last September.
Fredrick Manasseh, PharmD, said celebrities are pushing their use, and the television and TikTok are full of advertisement. “It’s the new, latest, greatest thing, right? Better life through chemistry,” he said. This has led to nationwide shortages of Wegovy and related drugs that have been in play for months. Manasseh explained that Wegovy was essentially the same chemical used in Ozempic, Rybelsus, Trulicity, and Mounjaro. Used to treat diabetes, these drugs were found to have a side effect of appetite suppression, so enterprising pharmaceuticals amped up the dosage and got FDA approval.
USI’s Larry Reece said the hypemeisters were controlling the narrative, but research was showing that about one third of patients prescribed GLP-1s will stop taking them due to adverse reactions, patients tend to regain weight once they stop taking the medication, and it is too early to know the long-term effects. For example, Reece said these weight loss drugs get rid of more than just fat. They also reduce bone density and degrade cartilage. “So what if someone’s consuming that for 20 years?” he asked.
Reece said the county had offered coverage for more traditional weight loss drugs in years prior, but “virtually nobody” filed claims for any of them. What’s more, a month’s supply of the traditional, frontline drugs costs only $100, whereas a month’s supply of Wegovy is now $1,349.02.
Chair Brownie Newman asked why the presenters weren’t discussing Wegovy’s benefits. Health experts have long been saying that weight loss can reduce risks for chronic diseases that stretch and drain insurance policies, like type 2 diabetes, hardening of the arteries, kidney disease, and osteoarthritis. In fact, in March, the FDA approved the prescription of Wegovy for reducing the risk of stroke and heart attack in patients already suffering cardiovascular disease.
Newman called attention to a recent New York Times article that announced North Carolina’s DHHS secretary, Kody Kinsley, had decided to have Medicaid cover GLP-1s for weight loss “because they feel like there are enormous public health benefits that are derived from utilization of these medications.” Newman wished he could see how the two-thirds of patients without adverse drug reactions were doing in five years. The USI reps said it wasn’t just a matter of investing up front for slow, high-yield returns in terms of lower utilization; taking Wegovy can induce chronic disease in previously healthy individuals, increasing healthcare costs now and later.
Commissioner Parker Sloan asked why the board was entertaining this highly unprecedented lengthy discussion about whether or not they were going to include a single drug in the formulary. “Interesting question,” replied Reece. “I think GLP-1 for anti-obesity has introduced that discussion at decision tables more than I’ve ever seen it in my career.” Historically, he said, the county has relied on the decisions of Blue Cross Blue Shield’s therapeutic committee, which meets four times a year to tackle problems like this.
Reece and Manasseh explained that BCBS will cover anti-obesity GLP-1s for their fully-insured patients in 2025, but it will be part of a wider program. Patients will need to demonstrate that they’re refractory to the first-line drugs. Then, they will have to enroll in a program that involves counseling, diet, and exercise, and they’ll be held accountable with checkups every few months. The commissioners will take this matter up again at their September 17 meeting.