08-03-2023_BoardBook

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doesn’t make sense to wait unAl someone has a BMI of 40 and in poorer health and costlier to the system, to allow them access to the most effecAve treatments. Requiring paAents to complete 3 months of lifestyle modificaAons to be candidates for GLP1s and to need to lose >3% of their body weight (or 2% BMI decrease for adolescents) is not evidenced based in predicAng someone’s degree of success with AOMs and is puniAve. Lifestyle changes are recommended for paAents with diabetes, hypertension, heart disease etc but none of these chronic condiAons require 3 months of a lifestyle modificaAon program to gain access to treatment. In truth, by the Ame paAents request help from a medical provider to treat their obesity, they have made mulAple a/empts at lifestyle change. Most of them have had success with weight loss but their story usually includes gradual weight recurrence due to the chronic and relapsing nature of obesity, not the paAents’ lack of diligence with diet and exercise. This is why AOM’s are recommended to be used long term for opAmal weight maintenance. Requiring renewal of the PA every 3 months is burdensome to provider, paAent, and your system for a long-term medicaAon. Again, this is not required for any other chronic disease. Your renewal criteria also require a paAent to lose 5% of their body weight (>4% reducAon in BMI% for adolescents) with the first 3 months of iniAaAng any AOM. This is oXen not long enough to decide a paAent is not responding to a parAcular treatment. Indeed, you propose a weight loss of 5% within 8 weeks of starAng the GLP-1 semagluAde ( Wegovy) when the dose is sAll being Atrated up and is unfair. Requiring a 10% body weight loss by 12 weeks to gain renewal on semagluAde means someone weighing 400 lbs will need to have lost 40 lbs. Most obesity specialists consider losing 1 lb a week as good, steady weight loss and 2 lbs a week as excellent. This would mean 12-24 lbs in 12 weeks is good to excellent weight loss. Therefore, for a 400 lb person, requiring 40 lbs is unrealisAc and puniAve. In the STEP Trials for Wegovy, they showed an average weight loss of 15% over 68 weeks. Your requirement of 15% loss at one year for renewal is cucng the Ame short. Metabolic co-morbid condiAons such as diabetes and hypertension have been shown to be improved aXer just 10% body weight loss. Using a 10% criteria for Wegovy, similar to that for Saxenda seems more in line with the ulAmate goal which is to improve overall health. Requiring paAents go up to the highest dose of semagluAde or be taken off medicaAon is also rooted in bias and sAgma around the disease of obesity. We do not do this with any other medicaAon. We as clinicians pracAce medicine by under an oath of “first do no harm.” To require paAents to increase their dose is again puniAve and medically inappropriate. Some paAents are high responders to this medicaAon and if it was not flat priced it would actually save money for you if they remain on the lower dose. Let’s advocate for pricing change with pharmaceuAcal companies such that staying on a lower dose adds value to care vs requiring a higher dose regardless of outcome and side effects. Requiring this higher dose is pracAcing medicine. Members of the OMA are powerful advocates for our paAents. We work Arelessly to improve access to obesity treatments throughout the country at both the local (state) as well as federal levels. To that end, the OMA respecnully requests the Kansas Medicaid reconsider the proposed PA criteria for limiAng your beneficiaries’ access to the prescribed obesity treatments they need in achieving opAmal health. Should you have any addiAonal quesAons or wish to speak with us directly, do not hesitate to contact us; our full contact informaAon is below. We are happy to provide more reasonable recommendaAons that can also be set forth to control cost.