Vida Health

As we begin the transition between administrations, we find ourselves in a sort of limbo, not unlike the shoulder season in a mountain town.  It’s time to brace ourselves for the uncertainty ahead. A prime example of this uncertainty emerged last week when the Biden administration proposed extending Medicare and Medicaid coverage to weight loss medications like Wegovy and Zepbound. If finalized, this decision would significantly expand access to GLP-1s for millions of Americans and clearly, effectively recognize obesity as a condition requiring medical treatment.  This move could have far-reaching implications for commercial health insurance plans. The proposal’s impact Under the new policy, an estimated 3.4 million Medicare beneficiaries and 4 million Medicaid enrollees would become eligible for obesity medications, at an estimated federal cost of $36 billion over 10 years. With bipartisan support and public interest growing—61% of Americans support Medicare coverage for obesity drugs—this policy could mark a turning point in how obesity is treated in the U.S. The evidence is clear that GLP-1s improve overall health, not just by aiding weight loss but by reducing the severity of obesity-related conditions, but critics are right to be concerned about high costs. A new reality for commercial plans If Medicare and Medicaid expand their coverage, commercial health plans will face heightened pressure to follow suit. It’s soon becoming table stakes to stay competitive in attracting and retaining members. Commercial plans still on the fence about covering obesity care may want to consider the following: Comprehensive Care Models: Just as CMS highlights the importance of using GLP-1s alongside broader obesity management strategies, commercial plans can partner with a solution like Vida that integrates nutrition counseling, mental health, and preventive care to maximize outcomes and mitigate costs. Workforce Implications: Employers are increasingly focused on workforce safety, retention, and productivity. Providing coverage for obesity care could be a way to meet those goals. Expanding Indications: These medications aren’t going away. In fact, the FDA may soon approve them for sleep apnea, kidney disease, fatty liver, and more. It’s better to get a strategy in place now for effective wraparound care and cost management. A catalyst for change For commercial health plans, the expansion of government coverage could be a catalyst for change. As one CMS leader noted, “The more friction there is in the system…the harder it is for people to get the care they need.” Removing those barriers may be the key to ensuring equitable care across all populations. I’m curious: how is your organization responding to the rising demand for GLP-1s?

We're leaving Brooklyn completely energized! Thanks to The Conference Board for hosting yet another incredible event. A few highlights: 1. GLP-1s and obesity continue to be top of mind for employers - 2025 is sure to be another exciting year. 2. Education matters! People want to learn HOW to become better stewards of their health 3. The healthcare system is getting easier to navigate, but we have some work to do with ensuring our member's pharmacy benefits remain integrated and easy to access. 4. On a personal note, I got to moderate my first major roundtable chat with Nina M. Auffart , MBA, SHRM-SCP and Gretchen Zimmermann, MBA, RD, LD, CDCES, CSOWM. We are lucky to have great clients with even better stories to share about their people. Thank you both! I'll see many of you on the road next year :)