Proposed Expansion of Anti-Obesity Medication Coverage for Medicaid Beneficiaries: Implications for MCOs
The Biden-Harris Administration has announced a significant policy proposal that could have a major impact on Medicaid beneficiaries and MCOs across the country. The new rule aims to expand access to anti-obesity medications (AOMs) for Medicaid beneficiaries, an essential move as obesity rates continue to rise in the U.S. This proposed change promises to improve health outcomes for millions of Medicaid beneficiaries, while also offering MCOs new opportunities to manage long-term costs related to obesity-related diseases such as diabetes, heart disease, and stroke. Here’s what MCOs need to know about this key proposal.
The Obesity Crisis and Its Impact on Medicaid
Obesity affects 42% of the U.S. population and is linked to serious coexisting conditions such as Type 2 diabetes, heart disease, and cancer, driving up healthcare costs. Medicaid beneficiaries are particularly vulnerable. New anti-obesity medications can lower the risks of conditions such as diabetes and heart disease, but their high cost, up to $1,000 per month, makes them inaccessible to many, particularly those on Medicaid.
Proposed Expansion of Coverage for Anti-Obesity Medications
The Biden-Harris Administration proposes expanding Medicaid coverage for anti-obesity medications, aiming to help 4 million adults access these treatments. The rule would reduce out-of-pocket costs by up to 95%, making medications more affordable for those who need them. For MCOs, this provides an opportunity to reduce long-term healthcare costs by addressing obesity early and preventing chronic diseases like diabetes and heart disease.
Addressing the Root Causes: Nutrition and Health
The Biden-Harris Administration’s National Strategy on Hunger, Nutrition, and Health also focuses on addressing obesity through prevention and nutrition services within Medicaid. For MCOs, integrating nutrition support, healthy lifestyle promotion, and weight management programs into Medicaid plans can help manage obesity and related conditions more effectively over the long term.
Key Takeaways for MCOs
Expanded Coverage for AOMs: Medicaid beneficiaries will have expanded access to anti-obesity medications, improving treatment options for obesity and related coexisting conditions.
Cost Savings Potential: By ensuring affordable access to these medications, MCOs can help manage healthcare costs over the long term by preventing the development of chronic conditions.
Care Coordination: MCOs will need to integrate anti-obesity medications into their care models, ensuring that Medicaid beneficiaries receive appropriate treatment and support.
Broader Healthcare Reforms: The proposed rule is part of a wider push to lower drug prices and increase healthcare access. MCOs will need to adapt to these changes and ensure that they are prepared for future shifts in drug pricing and coverage.
Conclusion
The expansion of Medicaid coverage for anti-obesity medications offers MCOs a unique opportunity to improve health outcomes for beneficiaries while managing long-term costs. By effectively integrating these medications into care strategies, MCOs can enhance access to critical treatments, reduce the risk of chronic conditions, and support the broader goal of making prescription drugs more affordable. Agilian is here to help MCOs navigate these changes, optimizing care models and ensuring that Medicaid beneficiaries receive the medications they need for better health outcomes.
According to the White House Fact Sheet, Biden-Harris Administration Takes Latest Step to Lower Prescription Drug Costs by Proposing Expanded Coverage of Anti-Obesity Medications for Americans with Medicare and Medicaid, the administration is prioritizing expanded healthcare coverage for vulnerable populations. (White House, 2023). Source.