2021-09-22 OMA Agenda - Board of Trustees

The State Health Benefit Plan covers about 500,000 lives, including state employees, teachers, public school employees, members of assembly, retirees, and their dependents. Efforts will now intensify to secure state employee coverage for obesity drugs. New Mexico Expands Obesity Drug Coverage in EHB Benchmark Plan The New Mexico essential health benefit (EHB) benchmark plan currently includes coverage for FDA-approved obesity drugs for those affected by morbid obesity. Beginning in 2022, the state will expand that coverage to include individuals affected by obesity, when medically necessary. Push for Medicaid Coverage of Obesity Drugs Continues in PA On June 21, 2021, Senator Joe Pittman introduced Senate Bill (SB) 782 — companion legislation to Pennsylvania State Representative Donna Oberlander’s House Bill (HB) 293, which would allow FDA-approved medications that treat obesity to be covered under the state’s Medicaid program, if managed care organizations decide coverage for these drugs is medically necessary. This is a major step as there has never been companion legislation introduced in the Senate since Rep. Oberlander began championing this issue four years ago. I continue to work with Ted Kyle and OMA Advocacy Committee members Vicki March and Verlyn Warrington to promote passage of HB 293/SB 782. As part of these efforts, I have coordinated numerous meetings with offices of Senators that sit on the Health and Human Services Committee – urging Committee Chair Brooks (R) and Ranking Member Haywood (D), to consider and pass SB 782. I have developed and coordinated with OAC on a state action alert to engage OMA Pennsylvania members to urge their state senator and state representative to support these respective bills. During 2020, I arranged and participated in several zoom meetings between Vicki, Verlyn, Ted and myself with key staff in Governor Wolf’s office and the Department of Human Resources to secure a more favorable budget score for the Oberlander legislation – getting the score reduced from $86 million to $9.5 million. Push for State Employee Coverage of Obesity Drugs in Wisconsin Building on successful efforts with Wisconsin STARs from Obesity Care Continuum groups such as the WI ASMBS State Chapter and the Wisconsin Academy of Nutrition and Dietetics (WAND) to secure bariatric surgery coverage for the state employee health plan, I am now working with OMA Advocacy Committee member Chris Weber and leadership from WI ASMBS and WAND on new outreach to the WI Employee Trust Fund (ETF) Group Insurance Board (GIB). I have set up an October 1, 2021 zoom meeting with ETF staff lead Renee Walk to urge the GIB to take the next step and now provide obesity drug coverage for state employees beginning gin 2023. Legislation Surrounding Obesity Treatment Coverage in Connecticut Health Plans Comes up Short! Connecticut State Senators Eric Berthel (R-32) and Saud Anwar (D-3) were unsuccessful in their efforts to pass legislation (SB-1007), which calls for the State Medicaid program and all private health insurance plans in Connecticut to provide robust coverage for metabolic and bariatric surgery and FDA-approved obesity drugs. While the bill did pass a number of procedural hurdles, the legislation was not included in the final budget package that Governor Ned Lamont signed into law during June. However, Senator Berthel was able to secure funding for a new study surrounding obesity care. Hopefully the results of the study will help drive change in the state. POTENTIAL FOR VICTORY MAKING PROGRESS