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Bill requiring Colorado insurers to cover weight loss drugs clears first hurdle despite analysis showing significant costs

Controversy at state Capitol over bill that would require Medicaid to cover weight loss drugs
Controversy at state Capitol over bill that would require Medicaid to cover weight loss drugs 04:07

Weight loss medications like Ozempic and Wegovy have been hailed as miracle drugs for people struggling with obesity, and under a bill at the state Capitol, insurers would be required to cover them.

"Of all the bills that I've done, this is by far the most personal," said state Sen. Dafna Michaelson Jenet. 

She told the Senate Health and Human Services Committee that she had struggled with her weight for years and was on the path to diabetes.

"I was almost at this spot where (on) my next visit I would be considered diabetic," she said. 

That's when her doctor prescribed Wegovy. It's one of about a half dozen new anti-obesity drugs and costs around $1,000 a month. Michaelson Jenet says she's lucky her state insurance plan covered it.

"Which gave me access to a life-saving, life-altering medication," she said. 

But most insurers won't pay for anti-obesity drugs. A bill by Michaelson Jenet and state Sen. Joanne Ginal would require state-regulated insurers and Medicaid to cover the drugs for Coloradans who are obese or pre-diabetic.

Fiscal analysts estimate the bill would cost the state $86 million in Medicaid in the first year alone.

Dr. Adam Gilden with Anschutz Health and Wellness Center at the University of Colorado warned the analysis was skewed.

"Because it assumes that every patient goes on an expensive, injectable medication and it does not model any of the downstream savings from treating obesity," he said.

A review of the bill's impact on insurance premiums also didn't account for any long-term savings, even though state law requires actuarial analysis of legislation to include both costs and benefits. Actuaries suggested it would be too complicated to determine the cost savings.

State Sen. Jim Smallwood and state Sen. Julie Gonzales said there's no excuse for omitting the data.

"It's not like we told actuaries 'You can include long-term health impacts if you want to and if it's really hard just don't do it.' We needed that," Smallwood told the Division of Insurance, which hired a consultant to conduct the review. It concluded premiums for state-regulated health plans would increase by more than $30 million in the first year alone if the bill became law.

Brandon Arnold with the Colorado Association of Health Plans warned it could run even higher.

"These drugs have such a cost that it is not possible to completely mitigate the ramifications," he said.

Dr. Jaime Moore with Children's Hospital Colorado disagreed.

"The heart attacks, stroke, kidney failure and dialysis, amputations, infections, these things that really represent significant cost savings especially if we intervene earlier. For adolescent girls who develop Polycystic Ovary Syndrome, PCOS is strongly linked to obesity and is the number one cause of infertility in the world. We would be preventing the cost of invitro fertilization."

The American Medical Association says obesity is linked to 200 other diseases.

Michaelson Jenet says the bill is also about health equity.

"Many, many people who need access to anti-obesity medications do not have access because of cost and insurance coverage. And today I want to fix that for some people."

Both the Colorado Division of Insurance and Department of Health Care Policy and Financing oppose the bill unless coverage of medications is removed. 

Michaelson Jenet and Ginal refused to amend the bill, which passed the Health and Human Services Committee 5-3. It now heads to the Senate Appropriations Committee where the cost estimates could doom it.

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