Placing You First Insurance Podcast by CRC Group
The Placing You First Podcast spans a diverse spectrum of insurance industry issues to keep you and your clients informed.
Placing You First Insurance Podcast by CRC Group
The Skinny on GLP-1s for Healthcare Industry Risks
Ever wondered how the latest advancements in GLP-1 medications are revolutionizing the treatment of diabetes and obesity? Join us for an insightful conversation with healthcare brokers Scott Scheiblin and Chip Wenges as they unravel the complexities and opportunities these groundbreaking drugs bring to healthcare providers. You'll discover the hidden pitfalls of improper prescribing practices, the looming threat of regulatory scrutiny over compounded medications, and the challenges posed by insurers limiting coverage to branded versions. As the demand for GLP-1s skyrockets, we discuss the implications and potential repercussions that could follow.
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Welcome back to the CRC Group podcast. Today we're diving deeper into one of the hottest topics facing healthcare providers right now GLP-1 medications. These drugs are shaking up the world of diabetes and obesity treatment, but as their use skyrockets, so do the risks for healthcare professionals. Scott, I think that you can agree with me. This is something we've been hearing more and more about in the healthcare insurance space.
Scott Gordon:Absolutely, and they seem to be everywhere. While GLP-1s do offer groundbreaking results for patients, they also represent a unique set of challenges, especially when it comes to liability, safety and coverage gaps for healthcare providers. And, lucky for our listeners, today we've got two great CRC healthcare brokers with us to help break it all down.
Amanda Knight:We're thrilled to welcome Scott Scheiblin and Chip Wenges, two seasoned healthcare brokers with CRC Denver, who are on the front lines of helping retail agents and their clients navigate the emerging risks tied to GLP-1s. This is the Placing you First podcast from CRC Group.
Scott Gordon:This podcast features news and insights from a vast knowledge base of over 5,100 associates.
Amanda Knight:Who write more than $35 billion in premium annually. Plus, we give you the latest information on what's happening at CRC.
Scott Sheiblin :This is the Placing you.
Scott Gordon:First podcast.
Amanda Knight:And now the hosts of the podcast, amanda Knight and Scott Gordon. Scott Chip, thanks for joining us today.
Scott Sheiblin :Glad to be here. Awesome Thanks for having us.
Scott Gordon:Yeah, thank you guys for helping us out here. So current research suggests that at least 12% of US adults report using a GLP-1. So let's start with a quick recap of the basics. I guess, Scott, can you briefly explain what GLP-1 medications are and why their use is exploding right now. Sure, sure.
Scott Sheiblin :GLP-1 medications were initially introduced for the treatment of type 2 diabetes medications like Ozempic and Wegovy and in sort of a happy coincidence, they found that it was having a major positive effect on weight for these patients. Those medications help to provide satiety and also regulate blood sugar and such. So out of that they have become incredibly popular prescriptions for what is, you know, an obesity epidemic in this country, for weight control, and we're seeing that go everywhere now. That go everywhere now. That goes across specialties from primary care physicians to you know you might have your dermatologist want to provide it to you. It's in digital health platforms. It has caused a explosion of compounding pharmacies doing it because of a short supply of the brand names. I mean, anecdotally, watching college football over the weekend, I think I saw four separate commercials for this stuff.
Amanda Knight:Wow, chip, can you walk us through some of the key risks for healthcare providers that are now jumping into the GLP-1 fray?
Chip Wienges:Sure, the biggest risks we're seeing are improper prescribing due to a lot of training, patient misuse of the drugs, particularly compounded versions and liability concerns from adverse reactions. There's a direct line between off-label use of a medication and misuse potential, and we're also seeing increased regulatory scrutiny and potential claims from patients who may not be properly monitored. There are a lot of positives to these drugs that have been well documented, but there is potential for negative outcomes. You can start with your typical digestive issues, but we're also starting to see acute kidney injury, suicidal ideation, pancreatic and thyroid issues. But we're also starting to see acute kidney injury, suicidal ideation, pancreatic and thyroid issues. Some more serious issues popping up, and those are just, you know, obviously have the potential to lead to more serious crimes.
Scott Gordon:So let's dive deeper into some of the regulatory issues. Scott, we've seen some FDA advisories around compounded versions of GLP-1s. How do you see this impacting providers?
Scott Sheiblin :Because of the shortages and the massive demand. You're obviously going to see, well, how do you make that work? And that has led to the proliferation of compounded versions using, specifically, sodium versions and acetate versions. The FDA has been pretty clear. The potential for adverse effects out of that are there and they're concerned about it. Yet those are also the most readily available. So where I see it impacting providers is I see the potential of insurance carriers to want to rein that in. You see it very much on the ENS side already where they're very focused and want to ask those questions and I think that that is going to continue across into the admitted side as well, where they're going to want to know what version of this are you prescribing, because anytime you have a version that the FDA says we're concerned about, I think if you follow a linear path of if that version leads to a claim, that's a pretty hard defense to have you prescribe something the FDA didn't say you should prescribe.
Amanda Knight:question I had in mind about you know are insurers pulling back? Are they pulling back on compounded but not the original versions? Do you guys have any insight?
Chip Wienges:Well, a lot of carriers are hesitant to cover compounded GLP-1s because of the FDA warnings and the lack of quality control. When you use a third-party pharmacy, you don't know exactly. If you control and use a third-party pharmacy, you don't know exactly. You don't know every time what you're getting. So we're seeing some carriers outright exclude these medications or limit the coverage to the branded versions, which creates challenges to providers who need to offer these treatments to their patients.
Amanda Knight:If there are FDA advisories and there are some clear issues. We've already seen lawsuits around GLP-1s. If I'm a physician and I don't specialize in, say, endocrinology for diabetes care or obesity treatment, why am I doing this? Because of demand.
Scott Sheiblin :Because the money to be made is just too lucrative, like what is pulling physicians in are being met with patients who want this medication.
Scott Sheiblin :They're being also met with the ability to prescribe it and see excellent margins, because this is not insurance reimbursable at that point with the compounded medications. So there is a need and that need will find a way to get filled. The FDA has stepped in and given some caution to that. Now, just to add as an extra point, again from a provider perspective, that's where you also want to be careful, because do you as a provider because you may never have actually had to think about this as a endocrinologist or a primary care provider prescribing a medication do you have an FDA exclusionary wording on your policy? Do you have something in your policy saying to you we will not cover you for non-FDA approved or off-brand FDA usage that are under advisory, whatever that may be? And I think that's somewhat of the risk that starts to be taken on when you start to use things that are under an FDA advisory, that are in that compounded version and that's where you know the compliance side of things can get scary for a provider right now.
Amanda Knight:Well, and we've already seen, like we said, some lawsuits around GLP-1 medications. I did some research and those don't seem to be slowing down. I know I read last week about several filed just based on side effects alone. Do we anticipate, based on that, that litigation is going to continue to grow and be a bigger concern for healthcare providers in this space?
Chip Wienges:Well numbers. The more widespread you know the exposure, the more adverse reactions and side effects you're going to have, and that's obviously going to lead to increased plant activity. So pretty simple equation.
Amanda Knight:Well, and it's also my understanding that these have not been around for all that long, so it's not like we have a lot of historical data on the long-term side of what these side effects or the long-term impact of using these can be.
Scott Sheiblin :Yeah, I think that's such an excellent point On so many different levels. That's an excellent point because you don't have the claims data to know what's going to happen. Yes, FDA approval has happened on those medications. So the FDA say on the brand aversion, it's okay, but you don't know on the compound aversion. This is very, very new From an insurance perspective. I think the maximum of insurance is you make decisions based upon the past, right, You're using the claims data and you're using all of that available to determine the go forward of how you want to cover something. This is so new and exploded so quickly that that claims data isn't there yet. So I think we're in for a couple of years until that figures itself out where things are going to change, and things could monumentally change. You could have the FDA could come out with another advisory and specifically say this formulation is very, very bad and we shift to another formulation. So it's shifting sands right now on this stuff.
Scott Gordon:Well, and this this question made the answer to this may change dramatically in the future as well, but let's talk about present day solutions. What steps should healthcare providers be taking right now to help mitigate these kinds of risks?
Scott Sheiblin :Yeah, I would say that you would probably want to educate yourself as to the best practices and procedures that you can possibly follow if you're going to be prescribing this. For instance, have you done the blood work on an individual? Have you measured their BMI? You know what version are you giving, what dosage are you giving. You know, are you giving ozembic for weight loss, for instance, versus? I believe zep bound is the one that is the sole FDA approved specifically for weight loss. So there's that side of things. And then on the next sort of side of it is okay, you follow the best policies, procedures you can. You determine what the risks are. You're aware of things like the FDA advisory. And then I think you need to work with your retail agent and who should be there to advocate for you to determine whether or not your policy is going to cover in the potential of a claim.
Scott Sheiblin :One thing I would say is that there is, I think, a belief out there that this, because of the widespread usage, this proliferates across the board in the books of many, many insurers, and I think that there's validity to that, but that doesn't mean that they're going to cover the claim. You know, making that assumption without an affirmative is not the same as having an affirmative, and so I would tell you, same as having an affirmative, and so I would tell you, especially if you're in something where weight loss or weight management may not have been a particular thought of this is what your practice would be doing. For instance, a dermatologist prescribing or I think we all remember when Botox became very popular, dentists started providing Botox. Do you know your policy is going to cover it? Do you know your policy has an FDA exclusionary wording or not? Those are things to protect yourself, because just because it's all over doesn't mean when the rubber meets the road a claim will get covered, and that's where I would tell people to be careful. That's where I would really counsel insurance.
Chip Wienges:And while you're on the do you know? Subject, as a provider, do you know the compounding pharmacy that you're utilizing? Do you know what kinds of quality control measures they're using? Do you know how overwhelmed they are? Have you worked with them before? There are all those questions as well, because there's no doubt there's a line between the compounding pharmacy and the provider, where you're leaning on them.
Scott Sheiblin :I think that's an excellent point Linkage of where claims could go on. This could easily go to well. First, the dose was wrong, the formulation was wrong. The compound pharmacy is going to be who's held responsible. But to back to the original, you as a provider, did you check that this patient should have this medication. Did you make certain of that? Because that's where you know, even if it is a problem of the medication, if you're prescribing something to someone without doing the necessary checks on somebody, without having met a standard of care that would make sense for prescribing a medication of this nature, you know you have the potential of liability existing. Even if the compounding pharmacy is ultimately responsible for the injury, you're at least contributing.
Amanda Knight:I also. I mean, I'm on social media, aren't we all? But I've also noticed that you can buy this stuff, like on the internet, and they will ship it to your house and then you have to give it to yourself.
Scott Sheiblin :Yes.
Amanda Knight:And I feel like there's got to be some liability there via, like, maybe that counts as telemedicine or something.
Scott Sheiblin :Well, there's the telemedicine part of it about. You know, are you prescribing across state lines? Do you have the proper licensure? There's all traditional telemedicine things that have to do with that. And then there's the added component of how much counseling and how much actual instruction have you given to a patient. I mean, I'll give you a couple of examples. Patient takes 0.5 milliliters of this and says, you know, I lost a pound or I was still kind of hungry. Well, I'm going to go ahead and take 1.5, because what the heck, and you know, 0.5 worked okay, 1.5 should work three times better.
Scott Sheiblin :Well, was there proper counseling, instruction plan to that person to make clear you cannot do that, even you know, yes, sticking yourself with an insulin needle from the vial that they give you and draw, you know. Again, I don't want to minimize, but may not be likely to cause a severe claim. However, you can still do something. You can still screw it up. Was there a video that showed you how to do things? Just letting people have this stuff and then not having either done it on the front end in terms of evaluation and also instruction as to how to actually administer the proper dosages and things, and also instruction as to how to actually administer the proper dosages and things. You're just piling up bricks to make it look like you have more and more liability at your feet.
Amanda Knight:In the process of writing the article we put together, I read about one lady who just there was a video but it didn't match the written instructions and somehow she gave herself like five times the prescribed dose and then her husband picked it up and he was like uh, I think that was too much, and you know she ends up in the hospital and-.
Scott Sheiblin :An attorney may argue what why'd you send her all that? Can't you send it to her every week in the just the dosage you need? You send her an entire vial that lasts a month, as opposed to an individual. You know that's some of what exists in terms of liability from those compounded versions. That is very different from the branded versions. Part of the branded versions, beyond formulation, that is different is the actual delivery method. It's a method that is made so that the specific syringe only has that amount in it. You can only inject that amount, and it's a one-time usage and disposable and it will not work again.
Amanda Knight:Right.
Scott Sheiblin :When you're using the compound versions and you are sending out this in larger dosage with a bag of needles— which is what happens and maybe a QR code you may not be seen by some as meeting the standard of care you needed to. That's a hypothetical, but you just may not.
Amanda Knight:Like either way, let's document exactly what we told people, because they're also going to YouTube and just watching other people's social media content and making decisions about how much to give themselves based on that, whether or not it's right or wrong. If you've documented this is exactly how much I have advised this person. Then at least it shows that you were very clear.
Scott Sheiblin :Yeah, we live in the time of social media giving health care instructions, social media giving healthcare instructions. So it's not odd for someone to go to TikTok and say, well, this is you know how X celebrity lost this amount of weight. And they followed it and they they throw out the regular instructions that they were given, which were maybe brief, and try something completely different. So, yeah, I think potentials for especially the delivery that kind of thing was, you know, help some of the teleplatforms is a little bit. It has sense to partner with CRC.
Scott Sheiblin :Healthcare has provided for decades and the strength of our collective healthcare group and I think to a certain extent the evidence is things like this. It is that the healthcare group tries to identify where new exposures, where new problems for our retail agents are going to exist, and work with them to find solutions. You know, this is a very new problem and this is a very new, or I should say, exposure that can create new problems. And we're trying to be proactive with our retailers so that they don't have to be on their back foot. We're going to do the work to figure so that they don't have to be on their back foot. We're going to do the work to figure out how to get this done for you now so that we can help you, and I think that's what we try to do at CRC Healthcare.
Amanda Knight:What do you think Chip Did? He say it all beautifully.
Chip Wienges:He pretty much said it all. It's not only the proactivity with the retail agents, it's the proactivity with the carriers as well. We've got access to the entire marketplace and we have been sending surveys, asking these questions, for months now, and so the breadth of information that we're able to compile and then pass along to our agents, you know it's, it's pretty large.
Amanda Knight:Well, I think you guys have made it through the hard part. Scott, what's next?
Scott Gordon:Oh man. The next is a little segment we like to call rapid fire, and this is where we just asked you guys some rando questions or maybe not so rando and try to just get the first thing that comes to your mind. So the first question if you weren't in the insurance world, what's a completely different career that you could see yourself pursuing?
Scott Sheiblin :Chip is going to have such a cooler answer than I am. I know it.
Chip Wienges:No, I'm not. In fact I'm trying to remove myself from the insurance world, but I can't do it completely because I think that I would go back, get a law degree and go into med companies. I don't think that's technically insurance, but I've always had so much just basic awe and respect for the attorneys that defend these claims and defend these clients, and that would just be amazing.
Scott Sheiblin :Well, you stole that answer, so I can't use that now. So, all right. So myself, over the last couple of years, I've developed a problem hoarding houseplants. The exact number is unknown at this point, so I think I would we're. It's getting bad. I'm almost to the point of learning their latin name. So it's getting bad, uh, so I think I would try to, uh, I think I try to hang a shingle and and sell my plants well, not my plants.
Amanda Knight:Sell other people's plants your plants are like family members. You can't do that.
Scott Sheiblin :Yeah, I've named them, so they can't leave.
Amanda Knight:I like it.
Scott Gordon:Ironically and those people listening can't see this but Chip is the one with the plants in the background. I know you're in the office, scott, but there you go.
Amanda Knight:Yeah.
Scott Gordon:Everybody loves a good plant, so our next question Last one yeah, so our next question, last one yeah, there's only two. I'm sorry. I know we wish this could go on forever. If you could travel anywhere in the world right now, where would you go and why?
Chip Wienges:Fresh on my mind, I would go straight back to where I was this weekend. My wife and my daughter and I went down to Franklin, tennessee, for a music festival. We go pretty much every Tennessee for a music festival. We go pretty much every year pilgrimage music festival. We had such a profoundly amazing time this weekend. I go right back there and I will for the next as long as that festival will be there.
Scott Sheiblin :That's good. I would go to Ireland. I love a place where you can wear a chunky wool sweater and I put on one of those caps and not feel like a dork. I think in Ireland it's okay. So it's my dream.
Amanda Knight:It's called a tam and it would look really good, is that what it's called? My husband has one. That's how I know.
Scott Sheiblin :I probably can't go to Ireland and say, hey, can you give me one of your dorky hats? That's probably not the way to Right International relations, not good that way.
Amanda Knight:I wonder you'd have to look up the customs rules. Can you bring home any Irish plants is the question.
Scott Sheiblin :Well, I mean, now we're figuring out my retirement plan.
Scott Gordon:Right, it's all just a bunch of moss anyway Sounds fantastic. Yeah, and grass grass for the sheep. Well, thanks, scott and Chip. This has been great. Thanks for sharing your insights and being such good sports. We never expected talking about diabetes or weight loss to be this much fun, but there you go. Thank you guys. Thanks guys.
Amanda Knight:And for all of our listeners. If you want to learn more or need help navigating these risks, please be sure to reach out to the CRC Group Healthcare team. We'll see you all next time.
