Published 9:47 am Thursday, Aug. 15, 2024
The Group Insurance Board today reviewed trends in health care market consolidation and the impact on the State of Wisconsin’s Group Health Insurance Program (GHIP). The Board also discussed approaches to coverage for weight loss drugs.
The Department of Employee Trust Funds (ETF) has provided an overview of national and state trends in hospital and health system mergers and acquisitions. Since 2019, Wisconsin has seen one merger and 14 acquisitions or proposed acquisitions by health systems.
Weight loss medications
ETF shared a analysis of coverage considerations for weight loss drugs, also known as anti-obesity drugs (AOMs) and glucagon-like peptide-1 (GLP-1) drugs. Federal laws and litigation related to weight loss drugs, developments in other states, and cost projections were reviewed.
Currently, AOMs are excluded from the GHIP form, administered by Navitus Health Solutions, under the terms of the Board’s contract, which expires on December 31, 2025.
Various approaches to covering AOMs were presented to the Board for consideration, including premium increases, increases in copayments and deductibles, benefit reductions, a pilot program, a lifetime cap, a new drug level on the AOM formulary, and increasing body mass index requirements to obtain coverage.
ETF pointed to the board’s health care strategy, which examines the impact of any change on members’ health and quality of life, program quality and affordability. The board must also comply with a state law that restricts changing or expanding program benefits without offsetting savings.
Below are the next steps in the panel’s ongoing review of weight loss drugs:
- November 2024 – ETF will provide an update on the latest developments in weight loss medications, revised actuarial cost projections, a holistic inventory of GHIP weight loss benefits, and an assessment of the utilization, cost, and quality of bariatric surgery offered since 2020.
- February 2025 – The Board of Directors is expected to award a new contract for the Pharmacy Benefits Manager for the 2026 plan year.
- May 2025 – The Board of Directors will decide on the cost coverage of weight loss medications for the 2026 plan year either in May or at a special meeting to be scheduled.
Miscellaneous
Last May, the panel suspended the requirement for vendors to submit a SOC-2, Type II cybersecurity report.
To ensure member data is protected, ETF recently implemented an Enterprise Provider Cybersecurity Framework that provides options for audit reporting and compliance with regulatory requirements and security standards such as the Health Insurance Portability and Accountability Act. These options allow providers to submit a SOC 2 report or any other report accepted by ETF.
The Board of Directors approved the following:
- ETF is entering into contract negotiations with HealthChoice (as agent) and Mutual of Omaha (as insurer) to administer a long-term care insurance plan effective January 1, 2025. The long-term care insurance program is available to state employees, retirees, their spouses, and the parents of employees, retirees, and spouses who are Wisconsin residents.
- The annual report of the Group Life Insurance Program for the year ended December 31, 2023, submitted by ETF and Securian, the third-party administrator of the program.
The previously agreed 5% premium increase for state life insurance will take effect on April 1, 2025. There will be no premium increase for local life insurance effective July 1, 2025. No premium increase is planned for the coverage of spouses and dependents for either plan.
The next regular board meeting will be on November 13, 2024.
