Good luck if you want to make sense of headlines about health insurance and coverage trends for GLP-1 medicines. Peruse the headlines and you can find just about any narrative you want.
“Rising health premiums push more small business to drop coverage,” according to Inc.
“Employers are opting out of covering GLP-1s,” claims Hines, a managed care company selling wellness programs as a substitute.
“GLP-1s will lower employer healthcare costs,” say the headlines from a new study.
“Driven by GLP-1s, prescription drug spending explodes at major health insurers” reports Stat News.
So really, the only thing that is clear about health insurance and GLP-1 coverage is the chaos of competing narratives, which flow quite naturally from competing interests.
A Comeuppance for PBMs?
It is not a sure thing yet, but Congress is poised to impose big changes on pharmacy benefit managers (PBMs) if the bipartisan deal on healthcare goes through. The byzantine ways of PBMs do a lot to frustrate people who need a GLP-1 for metabolic health.
Rena Conti is an associate professor of markets, public policy, and law at Boston University. She says:
“PBMs are kind of the last bastion of significant opacity in how our U.S. health care system works. And this is a piece of legislation that really aims to increase sunshine on how these entities are are functioning.”
Bringing transparency to PBMs has potential to reduce the consternation they can cause.
Growing Concern for Costs
The cost of healthcare is now the number one concern of Americans. Not housing. Not food. But healthcare. So because of this being an election year, you can be sure that public discourse about health costs will be intense.
Costs for obesity medicines have been dropping like a rock. People want access to these medicines because they can have life-changing benefits for their health. The destination is clear enough. More and more people will be getting these medicines and benefitting. Costs will keep coming down. But the ride will be bumpy along the way simply because my costs pay for your profits and every player in the healthcare system wants a piece of those profits.
So insurers threaten to drop coverage and customers protest. This natural dynamic and chaos along the way mark a process for gaining better access to real obesity care. Two steps forward. One step back.
Click here for more on GLP-1 coverage, here for perspective on the PBM reforms in play, and here for more on concerns about healthcare costs.
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