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New AMA policies target GLP-1 coverage, corporate medicine

The American Medical Association, one of the largest healthcare lobbying groups in the U.S., voted to adopt new policies to advocate for issues facing the healthcare community during its annual interim meeting held in National Harbor, Maryland this week.

Delegates in AMA’s policy arm voted on policies aiming to increase access to obesity care drugs, reduce the corporatization of healthcare and improve flexibility in treatment options for opioid use disorder

Here are the key policies that have been approved thus far:

Coverage of GLP-1s

The AMA House of Delegates urged health insurance coverage parity for evidence-based treatment of obesity, including Food and Drug and Administration-approved GLP-1 agonists.

The medicines, which can also treat diabetes, have been increasingly used as weight loss medications and may offer cardiovascular protections for those taking them. Some people have lost up to 15% of their body weight from treatment in testing, according to trial results. 

However, many insurers have been reluctant to cover the drugs for weight loss, noting they have to be taken indefinitely to be successful. Currently, the cost of GLP-1s without insurance is over $12,000 per year. 

Employers have been thus far reluctant to cover costs in plans. Only 25% of employers cover GLP-1s today, according to a recent survey by care delivery and navigation company Accolade, in part due to their price. 

Without assistance from insurers or employers, the cost of GLP-1s for weight loss can be a “significant access barrier” to people with obesity, the AMA said. Left as is, both the individual and system-wide costs of obesity, including the treatment of weight-related conditions and potential complications, would be “substantial,” the AMA warned.

The new policy is an “important step towards protecting the patient-physician relationship in determining the best course of treatment without barriers from payers,” the AMA said in a release.

Delegates urge ‘resistance’ to medical administrators

The AMA will advocate to resist corporate “encroachment of administrators” into medical practices, arguing that conflicting obligations between financial owners and clinicians have created tension between the two groups.

The association’s new policy seeks to rein in corporate oversight on medical decision making. The AMA noted that the growth of healthcare administrators — including chief medical officers and chief health officers — has surpassed the growth of clinical physicians in many practices, to the detriment of the field. 

The percentage of physicians working in private practices has continued to fall since 2012, as practices have been acquired by hospitals, private equity firms and payers. Corporate ownership is associated with higher patient costs and worse health outcomes, according to one study published in the British Medical Journal.

Delegates expressed concern that, without pushback from physicians, providers may soon feel pressured to make medical decisions based on costs that will ultimately harm patients.

“Traditional physician autonomy in patient care is now being influenced by pressures motivated by cost versus high quality patient care,” said AMA Trustee David Aizuss in a release.

For example, physicians may feel pressured to recoup costs by admitting patients from the emergency department who could be treated as outpatients, according to the AMA.

“We must continue to oppose encroachment of administrators upon medical decision making of attending physicians that is not in the best interest of patients,” Aizuss said.

Flexibility for buprenorphine prescribing for opioid use disorder

The association called for an elimination of buprenorphine treatment dose limits for patients with opioid use disorder, arguing that the nation’s worsening opioid overdose epidemic necessitates prescribing flexibility. 

Current dose limits are out of date and don’t keep pace with fentanyl addictions, which require higher dosages of buprenorphine to treat, according to the AMA. Presently, physicians abide by strict dose limits set by payers based on drug labels approved by the FDA.

Fentanyl and other synthetic opioids claimed the lives of 109,000 people last year, according to the AMA. The advocacy group said physicians must be empowered to use their clinical expertise to treat the disorder — not be shackled by dosage constraints.

“Our colleagues in addiction medicine are seeing efficacy of using buprenorphine products at higher doses than the current FDA-approved labeling, but health insurers and others prevent patients from receiving this medication in a timely manner,” AMA Trustee Bobby Mukkamala said in a press release.