OCC Advocacy Report | June 2022

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Senators Wicker & Gillibrand Bring TROA Support to 20 in the Senate!

At the time of this report, the Treat and Reduce Obesity Act had reached 167 total
congressional supporters with Senators Roger Wicker (R-MS) and Kirsten Gillibrand (D-NY)
becoming the 19th and 20th Senate cosponsors, respectively. House numbers reached 145
with the addition of Representatives Nikema Williams (D-GA), Greg Pence (R-IN), Trent Kelly
(R-MS), Vicky Hartzler (R-MO) and Andre Carson (D-IN).

OCAN members continue to meet with members of Congress and are hopeful that more
legislators will cosponsor TROA — especially in the wake of recent guidance from the
Federal Office of Personnel Management (OPM) spelled out specific guidance for health
insurance carriers that administer Federal Employee Health Benefit (FEHB) plans. In that
guidance, OPM clarified “that FEHB Carriers are not allowed to exclude anti-obesity
medications from coverage based on a benefit exclusion or a carve out”… and that “FEHB
Carriers must have adequate coverage of FDA approved anti-obesity medications (AOMs) on
the formulary to meet patient needs and must include their exception process within their
proposal.”

Obesity Community Efforts Lead Wisconsin Group Insurance Board to Schedule Special Hearing on AOM State Employee Coverage

In a May 16th letter, Obesity Action Coalition (OAC) President Joe Nadglowski expressed the
OAC’s “profound disappointment in the State of Wisconsin’s Department of Employee Trust
Funds (ETF) recommendation to the Group Insurance Board (GIB) that the Board NOT
provide state employee coverage for anti-obesity medications (AOMs) for 2023.”

Specifically, OAC took issue with the cost and utilization assumptions made by Segal that
ETF used for their recommendation – predicting a 3% utilization rate and annual cost of
$20-30 million. AOM utilization and real-world data from neighboring state employee health
benefits plans, including Minnesota and Michigan, in addition to data from Wisconsin
Medicaid, demonstrate that when access to AOMs is available, utilization has historically
tended to remain below 1% for patients with obesity. OAC also voiced strong objections to
the belief outlined in the ETF staff memo that “neither Segal nor ETF was able to determine
any projected savings from these drugs at this time… and that … ETF will continue to review
literature and cost-benefit analyses on weight-loss drugs as they become available to
determine whether these drugs should be added in the future.”

Finally, OAC raised concern that members of the Group Insurance Board were not receiving
all of the materials submitted by public stakeholders regarding this critical issue. For example,
OAC highlighted that comments made by the obesity community to ETF and GIB earlier this
year appear not to be in the official record as letters dated January 14, 2022 and April 15,
2022 were nowhere to be found under the “Board Correspondence” section of the agenda for
the May 18th or February 16th meetings. As a result of OAC’s efforts, GIB members decided
to table its final decision on AOM coverage until the Board can convene a special meeting in
June on the issue.