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Maryland advocates press insurers to add FDA‑approved anti‑obesity drugs to formularies; sponsors emphasize long‑term cost savings
Summary
Supporters of HB 10 31 argued anti‑obesity medications can reduce long‑term chronic disease costs and urged insurers to put approved drugs on formularies (not necessarily full coverage); PBMs and carriers said plan sponsors decide coverage and urged negotiation; witnesses described patient experiences and raised equity concerns.
Delegate April Miller urged the Health and Government Operations Committee on Monday to support HB 10 31, legislation that would require insurers to include FDA‑approved anti‑obesity medications on plan formularies and thereby increase access for patients with clinically significant obesity.
Sponsor testimony and patients: Miller described obesity as a chronic disease with large social and economic costs and said new medicines can reduce inflammation, improve mobility and prevent progression to severe disease. She and patient witnesses gave personal testimony: one witness said a medication helped her lose 60 pounds and regain health and mobility. Supporters argued that making these drugs available on formularies (even with cost‑sharing) allows patients to use manufacturer programs and negotiated pricing rather than rely solely on out‑of‑pocket retail purchases.
Clinical and public‑health case: The American Diabetes Association and other professional witnesses said obesity is the leading contributor to many chronic conditions and that evidence shows medicines can delay progression to type 2 diabetes and reduce downstream costs. ADA witnesses and clinicians testified that access would also address disparate impacts in communities of color and rural areas.
Insurer, PBM, and practical concerns: Industry witnesses, PBM representatives and some legislators pressed on the fiscal implications. Michael Johansen of PCMA and carrier witnesses said plan sponsors typically determine which drugs to place on formularies and at what cost share. They recommended plan‑level solutions — for example, placing drugs on a negotiated formulary tier with high member cost share while seeking manufacturer rebates — rather than a statutory mandate that could create large, uncertain fiscal impacts. Carriers asked for time and specific language to design benefit options that balance access and affordability.
Committee discussion and next steps: Members expressed sympathy for patient stories and asked about evidence on whether patients remain on medication long term and the potential budget effects. Several members said they wanted additional analysis of fiscal impacts and implementation options. No committee vote was recorded at the hearing.
