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Obamacare could cover weight loss drugs, a big bet on precision medicine begins to pay off, and banning surprise bills comes with its own surprises

February 20, 2024
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Reporter & Podcast Producer

Good morning! Who doesn't love a four-day week? We've got a lot of great stories today. The First Opinion on the interaction between weight loss drugs and mental health in particular is still rattling around in my brain.

Obamacare

Will Obamacare start covering weight loss drugs?GettyImages-631418810-1

Rhona Wise/AFP via Getty Images

Drugmakers are doing everything to meet the endless demand for new obesity drugs, and they might get some government help, STAT's John Wilkerson reports. Currently, Medicare is prohibited by law from paying for obesity drugs. State Medicaid programs don't have to cover them, so most don't. But the insurance exchanges that the Affordable Care Act (Obamacare) established to help consumers and small businesses shop for insurance are another market. And while ACA plans aren't currently required to cover weight loss drugs, that could change.

The Centers for Medicare & Medicaid Services, the agency that regulates this insurance market, is considering a technical change that would require insurers to cover obesity drugs in a market of more than 20 million Americans. If CMS were to replace its drug classification system with one that is not based on Medicare, it could require plans to cover obesity drugs as well as treatments for infertility and sexual dysfunction. The agency has acknowledged that a new system would be better for consumers — but how likely is an actual change? Read more from John.


personalized medicine

A big bet on precision medicine is starting to pay off

Six years ago, the National Institutes of Health placed its biggest-ever bet on precision medicine, launching a study to enroll over 1 million participants in an ambitious data-gathering gambit unmatched in its scope and diversity. Since then, Americans from all walks of life have been showing up and handing over their blood, spit, and pee to the project, dubbed "All of Us." From those samples, scientists have recovered a trove of new genetic information — more than 275 million never-before-seen DNA variants.

The data, reported yesterday in Nature, aim to address a longstanding lack of diversity in genomic datasets that has led to a narrow understanding of the biology of disease and undermined the promise of precision medicine. "The paradox of precision medicine is that you have to have a ton of different kinds of people to figure out one person really well," Josh Denny, CEO of the All of Us research program, said to STAT's Megan Molteni. "There's still so much we don't understand about the human genome, especially about rare variation. Huge projects like ours are really helping to accelerate that understanding." Read more.


health care

The unanticipated costs of banning surprise medical bills

Without question, the new federal law banning surprise billing is achieving its goal of protecting patients from enormous medical bills. But in doing so, the measure — which was initially projected to lower federal spending — appears to be raising costs elsewhere.

The Biden administration's new progress report on the process for arbitrating disagreements between insurance companies and providers, which covers the first six months of 2023, shows that in over 80% of payment disputes, the arbiter settled on an amount that was more than the median in-network rate for that service. To translate: Insurers were ordered to pay more to an out-of-network provider than they'd pay to a contracted one. The sheer volume of disputes also means the three federal agencies that run the program are devoting much more time to arbitration than expected. Read more about the report from STAT's Tara Bannow.



first opinion

The complicated relationship between weight loss drugs and mental healthAdobeStock_670573186

Adobe

It's known that mental illness can lead to or worsen obesity, and vice versa. With the rise of GLP-1 drugs, the menu of treatment options has increased, but so have the questions patients have about how these medications affect the body. Those questions range from "Will Wegovy make my depression worse?" to "Can I take Wegovy now that I've gained 50 pounds on the antipsychotic?" 

While we wait for more data to clarify the relationship between GLP-1s and mental health, experts say it is crucial for endocrinologists — who prescribe most of these drugs — and psychiatrists to work together to address the tangled connections between body weight and mental health. In a new First Opinion, physicians Jody Dushay and Karen Greenberg — an endocrinologist and psychiatrist, respectively — unravel what this means for patients. "The arrows connecting obesity and mental illness point in both directions," they write. "It is easy to overlook these double arrows, but our patients, doubly stigmatized, need our combined areas of expertise to determine the best path forward." Read more.


research

Study suggests women can exercise less than men while benefiting more (sorry lads!)

There's a sex disparity in exercise — but it may not be what you think. Women can exercise for less time than men but see better cardiovascular results, according to a new study published yesterday in the Journal of the American College of Cardiology. In general, regular leisure-time physical activity was associated with a 24% lower mortality risk for women but just 15% lower risk for men. The disparities emerge at higher levels of activity, the researchers found. Men saw maximal survival benefits after 5 hours of moderate to vigorous exercise per week; women saw the same level of benefits after 2 hours and 20 minutes per week. The disparity was consistent across both aerobic exercise and muscle-strengthening activity.

Researchers analyzed national survey data from 1997-2019 from more than 400,000 respondents. Possible explanations for the disparity could be that men have wider lung airways, larger muscle fibers, more lean body mass, and other attributes that give them greater exercise capacity than women, the study authors wrote, so that more activity is needed to see active improvement. But they also believe more research is needed to validate and expand on the results.


Artificial intelligence

AI regulations are taking shape — but startups demand more clarity

The federal government's plan to boost its oversight of the use of artificial intelligence tools in health care drew censure from startups arguing that overregulation stifles new ideas. But as Washington forges ahead, founders say they're in the dark about who will be regulated and how — and they're urging policymakers to offer clarity.

As they race for a slice of the $4 trillion U.S. health care market, AI founders and investors say regulatory uncertainty is a hurdle, forcing them to build more slowly and meticulously document for fear of potential audits. That makes it harder to keep up with the tech industry's breakneck pace, they tell STAT's Mohana Ravindranath.

"There's confusion, because there is no crystal clear guidance, and agencies are putting out slightly different guidance, binding or not binding," said Randi Seigel, a partner at law firm Manatt Health. Read more on the questions startup leaders are asking.


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What we're reading

  • Legal weed in New York was going to be a revolution. What happened? New Yorker
  • Leading MD Anderson oncologist disputes junior scientist's claims in lawsuit over research credit, STAT
  • In California, faceoff between major insurer and health system shows hazards of consolidation, KFF Health News
  • Readers on what human health care can learn from veterinary medicine and more, STAT
  • 'No one's coming to save us': Abortion campaigns scramble for limited cash, Politico

Thanks for reading! Until tomorrow — Theresa


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