10.25.2023 OMA Board Book

coverage for medications when prescribed for weight loss. However, OAC and ADA pointed out how that language merely advises that agents used for weight loss may be excluded from coverage (emphasis added). In no way is the state precluded from offering this coverage. These efforts led the state’s Medicaid program to adopt AOM coverage beginning in 2024! Governor Signs Obesity Care Coverage Bill for Connecticut Medicaid Program! On June 28th, Connecticut Governor Ned Lamont signed into law Senate Bill 977 – legislation that ensures access to anti-obesity medications (AOMs) and bariatric surgery for Medicaid patients with a BMI of 35 or higher. While the state’s Medicaid program already covers surgery, it had not previously covered AOMs. This is a huge victory for obesity advocates who have been working for years to expand treatment coverage in Connecticut! Obesity Groups Submit Comments Supporting AOM Coverage in Ohio Medicaid On June 29th, OAC, ASMBS, TOS and OMA submitted comments on the rules in Chapter 5160-9 of the Ohio Administrative Code, which are currently under review. Specifically, the obesity groups advocated for the removal of language that precludes coverage of drugs for the treatment of obesity in favor of language that will allow coverage for AOMs in the Ohio Medicaid Pharmacy Program under “covered prescribed drugs.” The obesity community cited how these changes will have lasting improvement on the health and well-being of Ohioans and the economic competitiveness of the state. Obesity Advocates Testify at Massachusetts Hearing on Medicaid Obesity Treatment Parity Bill Obesity advocates, such as OMA Advocacy Committee member Melinda Watman, testified before a June 6th hearing of the Massachusetts Joint Committee on Health Care Financing, which considered SB 754/HB 1198 — legislation that would mandate obesity treat ment parity in the state’s Medicaid program. Specifically, the bill calls for the program to require comprehensive coverage for treatment of obesity. The term “comprehensive coverage for treatment of obesity” includes coverage for prevention and wellness, nutrition counseling, intensive behavioral therapy, bariatric surgery, and FDA-approved anti-obesity medication. Texas ERS Relaxes some Bariatric Surgery Restrictions but Punts on AOM Coverage On May 11th, OAC responded to proposed changes in obesity treatment benefits for the Texas Employee Retirement System (ERS). In its letter, OAC encouraged the Board to modernize the HealthSelect obesity benefit by removing the current exclusionary language surrounding Food & Drug Administration (FDA) anti-obesity medications (AOMs) as well as strict limitations governing bariatric surgery coverage. While ERS did loosen some of the prior authorization restrictions surrounding bariatric surgery, the Board chose to hold off on AOM coverage until there is additional data on health outcomes associated with these medications. Obesity Advocates Caution State Medicaid Programs over PA Requirements During September, OAC and the OMA reached out to state Medicaid programs in Virginia and Kansas, respectively about these programs proposing overly strict prior authorization (PA) requirements. In its comments to Virginia Medicaid, OAC stated that it recognizes the program’s concern over the high cost of these new medications and understand some of the steps that DMAS is taking to control costs. While we would prefer to see the DMAS Service Authorization Form for Weight-Loss Management follow clinical guidelines and FDA-

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