Conquer Your Weight

Dr. Sarah Stombaugh: Before we get into the episode, I am thrilled to announce we are launching an online course, The GLP Guide. The GLP guide is a must have resource for patients who have been prescribed any of the GLP medications such as Wegovy, Ozempic, semaglutide, Zepbound, Mounjaro, tirzepatide, Saxenda, liraglutide. There are a lot of them and this course is available for anyone to purchase. We often hear from people who haven't been given much information about their GLP medications. No one has told them how to handle side effects, what nutrition recommendations they should follow, or what to expect in the long term. And it can be really intimidating and simply frustrating to feel like you're alone in your weight loss journey. With the GLP guide, you'll get access to all of the answers to the most common questions for patients using GLP medications, not sure how to use your pen, struggling with nausea, wondering how to travel with your medications. We've got you covered for only $97 for one year access. This is an opportunity you do not want to miss. The course is launching on October 1st. For more information and to sign up, please visit www.sarahstombaughmd.com/glp. You don't have to be on this journey alone. We are here to guide you. And now for today’s episode. This is Dr. Sarah Stambaugh, and you are listening to the Conquer Your Weight Podcast. Announcer: Welcome to the Conquer Your Weight Podcast, where you will learn to understand your mind and body so you can achieve long-term weight loss. Here's your host, obesity medicine physician and life coach, Dr. Sarah Stombaugh. Dr. Sarah Stombaugh: Hello everyone and welcome to today's podcast. I'm excited to bring on a guest today talking more about the Obesity Action Coalition. Today I have joining me Dr. Tracy Zvenyach. She is the Director of Policy Strategy and Alliances at the OAC, the Obesity Action Coalition. She is also a professor at Georgetown University where she teaches healthcare policy and advocacy to graduate level students. Dr. Zvenyach, thank you so much for joining us today. I'm excited to have you on the podcast. Dr. Tracy Zvenyach: Thank you so much. It's a pleasure to join you today. Dr. Sarah Stombaugh: Wonderful. Well, tell me a little bit more about yourself and how did you come to be involved with the Obesity Action Coalition? Dr. Tracy Zvenyach: So I'm the Director of Policy Strategy and Alliances at OAC, and we are the patient advocacy organization, right, representing people living with a disease of obesity and trying to find ways to improve access to care and as well as elevate the lived experience, get people's voices more heard, have patient representatives have a seat at the table. You know, this is a disease state that, while prevalent, it’s not well represented, you know, in policy circles, especially. So there's a big need for more advocacy in this space. And it's just an area of passion for me. I have, you know, family members affected by obesity, close friends affected by obesity. No one is untouched. And I am driven every day to improve access to care and improve quality of care because it's what people deserve. And it's a very great area of need. Dr. Sarah Stombaugh: Absolutely. Well, and so we are so grateful for that. And, you know, as an obesity medicine physician, I do this full time in my practice and seeing those advocacy things happening at a much greater level. I mean, the OAC is where it's at for advocacy. So tell me a little bit with OAC, what are some of the policy priorities that they are focused on right now? Dr. Tracy Zvenyach: Yeah, so OAC's policy priorities do fall under kind of two main focus areas, and they are, one, access to care, as well as ways to reduce and eliminate weight gain, weight bias and stigma and weight-based discrimination. And under Access to Care, we advocate for the full spectrum of evidence-based treatment options for obesity. So that's everything from nutrition counseling to intensive behavioral therapies, FDA-approved medications, devices, and surgical interventions as well. So we are agnostic to the type of treatment that someone gets and fully support that Thank you. We do access to care policy at the federal level. So we're working with Centers for Medicare and Medicaid Services. We work with the FDA. We work with the CDC, all of the federal agencies in that regard. And then, you know, we are also working with Congress to pass legislation that would improve access to care as well. We have a particular bill that we've been focusing on for a number of years called the Treat and Reduce Obesity Act, and that would correct some of the policy barriers that exist today that stand in the way of people getting the care that they need. So that's another focus area for us. And then things like CDC funding, NIH funding, you know, ensuring that we have the research to advance innovations and care, as well as programming, ensure that states have funding to do programs, as well as research. Working on the regulatory side to ensure implementation is sufficient so that that's a those are a couple of examples. From the access to care side, we also you know work with people every day when we hear about their insurance denying care. So how do you navigate your insurance company? How do you work with your healthcare provider to, you know, submit those appeals? And what does that process look like? And how can we provide resources and education and empower people to say, yeah, no, you deserve that care. And this is how you can appeal to get it. So that's another access to care area. And then, you know, a lot of access to care barriers are driven by weight bias and weight stigma. So we see this in policy that, you know, health insurance coverage policies have those exclusion provisions or many hurdles to access to care. We call them conditions of coverage. So different limitations or restrictions on how you can access your care, whatever the intervention is, right? And, you know, education and research about, well, a lot of those policies are rooted in discrimination. And how can we then update those policies targeting that weight bias, which then leads to better access to care? Dr. Sarah Stombaugh: Okay. So you guys are really, really busy from an advocacy standpoint. I love some of these things that you've described and it's been really a major issue. Certainly all of these areas, but there's been so much conversation recently from a coverage standpoint. And one thing, you know, we've certainly talked about on the podcast before, but I don't know that it really gets enough press, when we look at the coverage of particularly obesity management medications, it is very common that those are excluded on drug plans. And so you have your sort of standard healthcare plan. And if we're talking about a commercial insurer, for example, they are working with an insurance broker to determine a benefits plan for their company. And when they're doing that, they get the standard health insurance. And then there's carve outs for certain things. So there's carve outs for things like fertility treatment, for example. So they can opt into or opt out of that. And then there's also carve outs for the treatment of obesity. So insurers or rather employers can opt into or opt out of treatment for that. And the really challenging thing is, especially for smaller employers is that it may not even be offered to them as an option because it may be really cost prohibitive to opt into the treatment of obesity for their employees. And so this can be really challenging because then from a provider standpoint, there are patients who do have coverage and still there's hoops that we're jumping through to get that. And then there's patients just for whom there is nothing that I can say or do or no hoop that I can jump through in order to get those medications covered. And so this advocacy work is really, what needs to happen in order to start shifting that. So tell me a little bit about this, because there's been a lot of conversations and recent actions in the last and now current administration on obesity treatment coverage. Can you give us some updates about where that stands right now with the Treat and Reduce Obesity Act? Dr. Tracy Zvenyach: Yeah, sure. And the administration actions are related to the legislation. That's a really great point. So at the end of the last administration, they put out a proposed rule that would have required CMS under both Medicare and Medicaid to cover obesity medications, the FDA approved obesity medications. And so then the new administration came into office and they were reviewing that. And ultimately they finalized that proposed rule without the provision that included coverage of the obesity medication. So it was not added. So what... OAC and many of our partners in the advocacy community, we are continuing to engage with the new administration to identify a pathway and a framework for coverage for obesity medications. And the current administration is open to having that discussion. So OAC and several other groups are setting up meetings with CMS and HHS, the Office of the Secretary, to share information, serve as a resource, and demonstrate that there's great support to move in that direction to identify that pathway so that people can get access to care. So as it stands right now, that coverage did not go through the kind of the Under Medicare Part D, it is still prohibited for the obesity medications. Under Medicaid, it's still left up to the states to decide. So that did not go through. So that's all under a regulatory advocacy approach. Now, you mentioned the Treat and Reduce Obesity Act. That's a legislative advocacy approach, and that's for Congress to take action. So we do expect the legislation to be reintroduced because we are now in a new, you know, we're six months into a new Congress of the 119th, and that's a two-year period. So we're going at it again to, we had the tremendous bipartisan support last year. So we're going to advance those advocacy efforts again to try to get, you know, the continue that awareness, build, build support to advancing some level of care. But all of it goes hand in hand in parallel with that regulatory track too. So while they're technically separate, they're, they are. they're interrelated and they do influence one another. So we're working both to try to do everything we can to And every, you know, option and angle that we can take to advance this access to care. We're also working, you know, I've chatted a lot about the federal level. We're doing a lot at the state level too. So working on trying to update Medicaid coverage for all of the evidence-based interventions for obesity, you know, including the medications, including surgery, including, you know, behavioral therapies and nutrition coverage, you know, right now, in addition to Medicaid at the state level, also state employee plans. The states, as the employer, are oftentimes the largest employer in the state. So working with the state and how it covers its employees is another big focus area from an access to care perspective. And we've been seeing this interesting trend. evolution of some states are adding coverage in in areas like Medicaid and then maybe pulling back in their state employee plan. So we're in this very interesting time of making progress in some areas to advance access to care, but then seeing hesitations or, you know, some states are pulling back on coverage and other ways for obesity care. So it's from an advocacy perspective, it's a very active, busy time. And we're seeing this mix of steps forward and steps back at the same time. Dr. Sarah Stombaugh: Well, and it's always so interesting. You know, I imagine that someone is listening to this podcast episode in like 2027 and it's the future. And they're like, this is totally irrelevant. Why are they having this conversation? You know, every time I have a conversation like this, I'm like, let it be irrelevant in six months, right? Let us move forward in this way that we just get to look back at the challenging times and all the advocacy that has changed in moving forward. But it continues to be really, really difficult at this time. And so, as you said, with CMS, so the Centers for Medicare and Medicaid Services, they are regulating what is happening at a federal level for the coverage, particularly of Medicare, but then have that ability to sort of override from a Medicaid standpoint if they so desired. And right now, as you said, for patients with Medicare, these medications are not covered for a weight reduction indication. So they do have coverage for diabetes, so medications like Ozempic or Mounjaro, when used for the treatment of type 2 diabetes, may be allowed. We've also seen coverage, which has been really exciting, for some of the new medical indications. So the Wegovy medication, for example, for cardiovascular risk reduction, patients without history of cardiovascular disease, like a prior heart attack or stroke, for the Zepbound medication, also now for the sleep apnea indication. We've seen that CMS and Medicare has elected to cover those medications for those specific medical indications, which gives me a little bit of hope in terms of where is the future of this going. So when we think about that, CMS, it tends to be sort of the guideline for what happens to a lot of the other even commercial insurers. So tell me a little bit, this advocacy coming out of CMS and really focusing on that, tell me a little bit more about why the focus is there versus at sort of smaller levels. Tell me about that piece a little bit. Dr. Tracy Zvenyach: Yeah, no, that's such a great point. From a policy perspective, we focus so much on CMS policy because it influences the other payer types across the market. So Medicare will influence commercial payers, will influence employer coverage decisions. So it has a very wide reach when CMS makes payments. makes a policy. So that's the core reason why we focus there so much. So when we're fighting for policy change in Medicare, yes, it will benefit older Americans and some that qualify with disabilities, but it really can affect all of Americans' coverage. Dr. Sarah Stombaugh: Okay, wonderful. And we see that in so many other areas as well. And so it makes a lot of sense that we would anticipate that. And I'm really hopeful to... As we start stacking up, you know, all these medications are being studied for other clinical indications as well. You see them being studied for kidney disease or for osteoarthritis or for dementia, certain inflammatory arthritis, for example. And so and certainly other other conditions as well. And it's like, OK, as we're sort of stacking up some of these medical indications, does that start to to shift the tide on this? Then, of course, in combination with with advocacy piece. Dr. Tracy Zvenyach: Yeah. Tell me a little. Oh, God. I was just going to completely agree that with the innovations and new indications, we're going to continue to see this momentum of more coverage. And then I think we also expect to see, and this is the part we'll probably laugh at in a few years, is that with more products coming to market and with various administrations, we do expect, you know, the cost issue to be addressed over time and for this class of treatment to just will be more affordable. So I look forward to that day where it is more affordable and where it is part of the standard of care and part of the standard benefit for the insurance design. That's really... the aspiration and where we want to see this space, you know, evolve to. And ultimately that will improve patient care and it will improve the health and wellbeing of people living with obesity. Dr. Sarah Stombaugh: Absolutely. When it really comes down to the cost, right? When we're thinking about the conversations they've always focused on, well, the cost of this would be so cost prohibitive. And there's been studies that have shown what that would do from a savings standpoint. You know, certainly there is this upfront investment that insurance companies are needing to make. And that's really happening at a national level and happening across everyone at once makes the difference of, okay, if we're all sort of paying into this, then we all reap the benefits of that investment. 10, 20 years down the road as we're seeing the reduction of all of these other health conditions. Dr. Tracy Zvenyach: Absolutely. And that's really how we're trying to work with the payers, whether it's a government payer or a private payer, you know, to have them understand how to model their numbers differently. They haven't had to think like this before, given that, you know, obesity is, you know, the root driver of, you know, those 200 plus complications. They've never had to like run their numbers in this way before. So that's a big education. step that we've been doing for quite some time now, but we'll have to continue to do that so that they can see where the cost offsets are, see where the savings is bubbling up because it's there. We just need to help the payers understand that there's value to investing in this and where they will see where they will see those benefits, not to mention, you know, healthier people, you know, better quality of life, well-being. That's really what that's really what we're aiming for, for patients. Dr. Sarah Stombaugh: Yeah, absolutely. And tell me if someone is listening to this and they're wondering, oh my gosh, this is really important work. I'm interested in getting involved in helping to advocate for the care of obesity. How can they learn more and get involved? Dr. Tracy Zvenyach: So we welcome all voices to help our cause and help our mission here at OAC. easy ways to get involved you know we have we have ways to advocate that take about 30 seconds and we have ways to advocate where you know you can you can come to Washington DC with us and go to Capitol Hill so we have advocacy that can be can fit someone where they're at if they want to get involved our website obcaction.org there are lots of opportunities there anyone's always welcome to reach out to myself directly or anyone at OAC we'll get you to the right spot. Another great offering that we have at OAC is our community and our support. Upcoming in July, July 24th through 26th, we will have our Your Weight Matters National Convention in the Washington, D.C. area. And that's a wonderful convention where patients and providers, other folks come together for great evidence-based education, as well as lots of community and support. We're going to have tons of advocacy opportunities. We're going to be taking a group to Capitol Hill. So it's a wonderful experience to come learn and just share in the experience in the community of OAC. Dr. Sarah Stombaugh: Okay, that's really wonderful. And so it sounds like whether you're talking about 30 seconds, I imagine, you know, emails, for example, you know, that's one of the most important things you can do is reach out to your representatives. There's some really good forms on there in terms of like, here's a standard letter that you can, that you can submit or even to your own HR. I believe you guys have some stuff there as well about advocating for the coverage of anti-obesity medications in your own employer. So you can send, get some sort of generic forms there that you can fill out and submit in order to advocate for yourself or for other people in your employer. As well as then things are a little bit more involved, whether it's going to the national meeting. And that's exciting because it's in Washington, D.C. So for those listeners who are local to me, I'm in Charlottesville, Virginia, and a lot of our listeners are in the central Virginia area, although we do have listeners everywhere. Great opportunity to get up to D.C. and do that. I also loved you mentioned some of the prior authorization and appeals thing. I think from a health care provider standpoint, that can be so valuable because you It is really common. Patients will come into my practice sometimes and say to me, oh, hey, I don't have coverage for these medications. And then they're starting to look at cash options, for example. And then I ask them who their employer is. I'm like, no, you should have coverage for these medications. And it may be just a matter of doing the prior authorization appropriately. And those prior authorizations, while some of them are pretty standard, every once in a while, there are some that are really wonky. And they start asking some questions and you're like, oh, do I answer? Yes. because I'm trying to prove this thing? Or is it no, because I'm trying to say, you know, like, you know, has the patient lost a certain amount of weight in a certain amount of time? And it's like, oh, are we proving that? Yes, it's been effective off of medication. And so therefore they should keep doing that or lifestyle intervention has not been enough. So therefore they need the medication. And it can be really challenging unless you do those day in and day out to really know how to do some of those properly. And you guys have some really great resources there. Dr. Tracy Zvenyach: Yeah, we definitely do. And, you know, we're always happy to, you know, hear what the specific situation is and try to, you know, walk someone through the process or give ideas of how to manage that. But, you know... Yeah, absolutely. required for documentation and reporting and things like that. The hope is that that would be addressed. You mentioned you're in Virginia. We also have ways to get involved locally within your state or even within your community, depending on the issue, the advocacy or policy issue that we're focusing on. We've got We've been working on Virginia Medicaid as an example. My colleague Sarah Bramblette at OAC is establishing state action teams for advocates that could be patients or providers to get involved with OAC so that when an issue comes up in the state, we have like a core team that's ready to, you know, it can be as simple as sharing a story. It can be as simple as, you know, right, you know, helping write a letter, write an op-ed. And so we have those local opportunities available as well. Dr. Sarah Stombaugh: Okay. That is so wonderful. And what we'll definitely do in the show notes of the podcast, have information for the OAC, the Obesity Action Coalition, and link some of these things. So it's really easy. If you're listening to this episode, you can just pop down there, go exactly where you need to go. We'll try to make that simple. I always tell my listeners too, you can reach out to us at info@sarahstombaumd.com. If you have more specific questions that we can help point you in the right direction, I can maybe answer those or point you in the direction of others in the OAC as well. Well, Dr. Zvenyach, thank you so much for joining us. Thank you so much for joining us today. This has been really fun. Dr. Tracy Zvenyach: It was my pleasure. Thank you so much. Dr. Sarah Stombaugh: Wonderful. All right, everyone. We will see you all next week.