08-03-2023_BoardBook

7173 S. Havana St #600-130 Centennial, CO 80112 P: 303.770.2526 | F: 303.779.4834 obesitymedicine.org

July 18, 2023

Anne/e Grant, RPh KS Medicaid Pharmacy Program Manager

Sarah FerAg KS Medicaid Director

Dear Anne/e and Sarah,

The Obesity Medicine AssociaAon (OMA) is an organizaAon of nearly 5,000 expert medical clinicians who treat the chronic and relapsing disease of obesity. One of the challenges our providers and their paAents face is the lack of coverage for the treatment of obesity, inclusive of effecAve FDA-approved anA-obesity medicaAons (AOMs) It has come to our a/enAon that Kansas Medicaid has been extremely forward thinking by providing coverage of AOMs since 2014 but now is planning to insAtute Criteria for Prior AuthorizaAon (PA) that will significantly restrict access paAents have to these powerful tools to treat their disease. The people in your Medicaid program with lower socioeconomic status are parAcularly vulnerable to obesity and have a higher disease risk than those with more means and educaAon. In your draX PA Criteria, you refer to AOMs as ‘Weight Loss Agents’ which implies treatment for a lifestyle problem to a degree rather than a treatment for a chronic disease. The American Medical AssociaAon (AMA) defined obesity as a chronic disease in 2013. Science has shown that obesity is not the liability of an individual’s lifestyle, but instead, obesity represents a complex and mulA-factorial disease. Obesity has geneAc origins with biological, environmental, and cultural influences which display differently in each paAent. Changing the nomenclature from “Weight Loss Agents” to Obesity Treatments or AnA-Obesity MedicaAons is a be/er representaAon of this class of drugs. Of the AOMs listed in your PA Criteria draX, it is unclear why generic, inexpensive medicaAons like phentermine or diethylpropion would require a PA at all. Phentermine/topiramate (Qsymia) and bupropion/naltrexone (Contrave) are also more reasonably priced and should be excluded from PA. Making providers renew PA every 3 months during treatment is excessive and will be costly. Michigan repealed their PA criteria when they weighed the Ame and money spent implemenAng the policy versus lecng doctors use their experAse when making decisions about medicaAon that is best for their paAents. It is the bias and sAgma surrounding the disease of obesity that has required a PA for a $10 generic medicaAon such as phentermine. By eliminaAng prior authorizaAon on lower cost medicaAons this will encourage prescribing of these drugs iniAally to reduce the use of costly newer medicaAons. We understand the need to have the more expensive GLP1 agonist type AOMs, semagluAde (Wegovy) and liragluAde (Saxenda) under a second Aer requiring PA. The draX criteria states that only those with ‘severe obesity’ with a BMI over 40 or adolescents with BMI > 140% of 95% will qualify for GLP1s. PaAents with a BMI 30-39 can have severe disease when they also have any of the 14 co-morbid condiAons listed in Table 2. It