Posted 9:47 a.m. Thursday, Aug. 15, 2024
The Group Insurance Board today reviewed trends in healthcare market consolidation and the impacts on the State of Wisconsin Group Health Insurance Program (GHIP). The Board also discussed approaches for the coverage of weight-loss drugs.
The Department of Employee Trust Funds (ETF) provided an overview of national and state trends in hospital and health system mergers and acquisitions. Since 2019, there has been one merger and 14 acquisitions or proposed acquisitions by health systems in Wisconsin.
Weight-Loss Drugs
ETF shared an analysis of coverage considerations for weight-loss drugs, also known as anti-obesity medications (AOMs) and glucagon-like peptide-1 (GLP-1) drugs. Federal legislation and litigation related to weight-loss drugs, what is happening in other states, and cost projections were reviewed.
Currently, AOMs are excluded from the GHIP formulary managed by Navitus Health Solutions, per the Board’s contract terms. This contract expires December 31, 2025.
Different approaches for the coverage of AOMs were presented for the Board’s consideration, including premium increases, copay and deductible increases, benefit reductions, a pilot program, a lifetime limit, a new AOM formulary drug level, and increasing body mass index requirements to obtain coverage.
ETF noted the Board’s Healthcare Triple Aim strategy of examining the effects of any change on members’ health and quality of life, program quality, and affordability. The Board also must adhere to a state law that limits the modification or expansion of program benefits without offsetting savings.
Below are immediate next steps in the Board’s ongoing review of weight-loss drugs:
- November 2024 – ETF will provide an update on the latest weight-loss drug developments, revised actuarial cost projections, a holistic inventory of GHIP weight-loss oriented benefits, and an assessment of utilization, cost and quality of bariatric surgery offered since 2020.
- February 2025 – The Board is expected to award a new pharmacy benefits manager contract for the 2026 plan year.
- May 2025 – The Board will decide on the coverage of weight-loss drugs for the 2026 plan year either in May or at a special meeting to be scheduled.
Other Business
Last May, the Board suspended its requirement that vendors provide a SOC-2, Type II cybersecurity report.
To ensure protection of member data, ETF recently implemented an enterprise vendor cybersecurity framework, which provides options for control reporting and compliance with regulatory requirements and security standards, such as the Health Insurance Portability and Accountability Act. These options allow vendors to submit a SOC-2 or other report accepted by ETF.
The Board approved:
- ETF initiating contract negotiations with HealthChoice (as agent) and Mutual of Omaha (as insurer) to administer long-term care insurance, 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 reside in Wisconsin.
- The Group Life Insurance Program Annual Report for the year ending December 31, 2023, which was presented by ETF and Securian, the program’s third-party administrator.
The previously adopted 5% premium increase for state life insurance will be effective 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 a spouse and dependents for either plan.
The Board’s next regularly scheduled meeting is November 13, 2024.