Breaking News

Insurers push back on weight loss drugs, a Fauci successor is chosen, & uninsured Americans hit record low — for a minute

August 3, 2023
Reporter, Morning Rounds Writer
Good morning. Be sure to check out the reaction from insurers to the effective, expensive, and wildly popular weight loss drugs, plus news on a new NIAID leader and a new low for the rate of uninsured Americans.

The obesity revolution

Insurers balk at covering costly weight loss drugs 

Marian Moratinos for STAT

New drugs that induce weight loss are both extremely effective and remarkably expensive, with list prices of $900 a month, and they're meant to be taken indefinitely. Now insurance companies are clamping down, whether that means denying coverage, discouraging doctors from prescribing the drugs, or demanding a specified diagnosis from pharmacists before they fill doctors' orders. Originally developed to treat diabetes, these GLP-1 drugs threaten to send health care costs spiraling even higher, particularly if new research bears out scientific hunches that they'll translate weight loss into better cardiovascular health. 

That's leaving patients in the lurch as different insurance companies employ different ways to say no, even if they previously covered the drugs when prescribed off-label, as doctors are allowed to do but insurers may no longer buy. "We're making so many advances in the science of obesity," said Angela Fitch, chief medical officer at health provider Knownwell and president of the Obesity Medicine Association. "And yet patients can't get access to it." STAT's Elaine Chen tells us more.


research

Infectious disease expert Jeanne Marrazzo will succeed Fauci at NIAID

Roughly eight months after longtime director Anthony Fauci stepped down from the National Institutes of Allergy and Infectious Diseases, we have a nominee to succeed him. University of Alabama at Birmingham infectious disease director Jeanne Marrazzo will take charge of the $6.3 billion agency this fall, just as Congress takes up the institute's budget. Unlike President Biden's stalled nomination of current cancer chief Monica Bertagnolli to lead the NIH, Marrazzo does not need Senate confirmation. 

Marrazzo, who studies sexually transmitted diseases in female reproductive systems, is "very well-liked, very respected," and experienced, Fauci told STAT's Sarah Owermohle. "She's going to be a good fit. It's a great challenge that she's going to be facing; it's going to be exciting for her." Sarah tells us Marrazzo, whose Twitter background shows her in a camper van, regularly shares infectious disease information between retweets of happy goat videos and WeRateDogs tweets. Read more.


drug development

A non-opioid pain drug from Vertex meets a goal

Even Vertex executives have compared the company's labors developing safe, potent molecules for pain relief to working in a graveyard for drug discovery, STAT's Jonathan Wosen reminds us. Yet data published in NEJM yesterday offer a glimmer of daylight for an experimental non-opioid treatment that reduced post-surgery pain: The drug kept signals from pain-sensitive neurons from reaching the brain in two mid-stage clinical trials. When given in high doses, participants were less likely to stop their treatment early because it wasn't working than those on placebo or those who took acetaminophen with  hydrocodone.

The pain reduction reached statistical significance, but an editorial appearing with the study called the effect "small." Phase 3 trials are now underway, with results expected by the end of this year or early next. The stakes are high for producing a pain medicine without the addictive qualities of opioids. Read more.



Closer Look

Just before Medicaid ends for millions, the fewest Americans ever lack health insurance

You could call it a bittersweet victory. As of March, the latest period for which health insurance data were analyzed, only about 7.7% of Americans had no coverage, a new low. Since then millions have lost Medicaid coverage, which was extended during the Covid pandemic after Congress gave states extra federal Medicaid funds. There were strings attached: States had to loosen eligibility requirements and keep more people enrolled.

Medicaid enrollment soared by 33% between February 2020 and April 2023, when the program covered more than 94 million people. Then states began removing people from Medicaid programs if they no longer qualified or had other sources of coverage. But health policy researchers at KFF estimate three-quarters of the 3.8 million low-income adults and children who lost their pandemic-era Medicaid coverage did so due to "procedural reasons." STAT's Bob Herman has more, including what insurers say. 


business

How Humana and CVS hope to turn members into patients

Primary care for older adults is looking hot. Yesterday Humana and CVS Health promoted their intention to build up their primary care clinics for seniors and send Medicare members there. UnitedHealth Group has already gone down this road, as the largest Medicare Advantage insurer and one of the biggest employers of physicians. Now Humana is partnering with a private equity firm to add more CenterWell Senior Primary Care sites, while CVS bought the Medicare provider Oak Street Health in May.

Here's how STAT's Tara Bannow explains it: When insurers are also medical providers for their members, they profit enormously by lowering members' health care costs. That's especially true in Medicare Advantage, in which insurers are paid a set amount to cover members' medical costs. "It's in all of their best interests to have their own members in CenterWell and Oak Street," said Jon Kaplan, a senior partner with Boston Consulting Group. Read more.


health inequity

Lost without translation: Clinical trial consent documents pose a barrier for non-English speakers

When clinical trials recruit participants, they must gain their written consent before enrolling them. In cancer research, for the 70% of randomized trials sponsored by pharmaceutical companies, research budgets cover the cost of translating consent documents into the potential participants' language. For the remaining studies, that's not a certainty. Researchers at the UCLA Jonsson Comprehensive Cancer Center thought this gap might be low-hanging fruit for improving who is represented in research studies.

When they compared who among more than 9,200 participants signed consent forms, they found that half as many patients with limited English proficiency signed consent forms for studies not sponsored by industry compared to those that were. That matches the half as many documents translated by non-industry sponsors as by industry sponsors. "An important barrier for patients with limited English proficiency to participate in cancer studies may be the cost that consent document translation presents to investigators," the authors write in Nature.


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What we're reading

  • 'The cruelty Olympics': Texas workers condemn elimination of water breaks, The Guardian

  • Pharma industry showers House GOP doctor with campaign cash, STAT
  • Testing your genes for cancer risk is way cheaper now — and it could save your life, NPR

  • Opinion: Without a plan to fight superbugs, the Cancer Moonshot will never achieve liftoff, STAT

Thanks for reading! More tomorrow,


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