October 18, 2024 • 24 mins
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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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Amanda Knight (00:00):
Welcome back to the CRC Group podcast.
Today we're diving deeper intoone of the hottest topics facing
healthcare providers right nowGLP-1 medications.
These drugs are shaking up theworld of diabetes and obesity
treatment, but as their useskyrockets, so do the risks for
healthcare professionals.
Scott, I think that you canagree with me.
(00:23):
This is something we've beenhearing more and more about in
the healthcare insurance space.
Scott Gordon (00:28):
Absolutely, and they seem to be everywhere.
While GLP-1s do offergroundbreaking results for
patients, they also represent aunique set of challenges,
especially when it comes toliability, safety and coverage
gaps for healthcare providers.
And, lucky for our listeners,today we've got two great CRC
(00:49):
healthcare brokers with us tohelp break it all down.
Amanda Knight (00:53):
We're thrilled to welcome Scott Scheiblin and
Chip Wenges, two seasonedhealthcare brokers with CRC
Denver, who are on the frontlines of helping retail agents
and their clients navigate theemerging risks tied to GLP-1s.
This is the Placing you Firstpodcast from CRC Group.
Scott Gordon (01:11):
This podcast features news and insights from
a vast knowledge base of over5,100 associates.
Amanda Knight (01:17):
Who write more than $35 billion in premium
annually.
Plus, we give you the latestinformation on what's happening
at CRC.
Scott Sheiblin (01:24):
This is the Placing you.
Scott Gordon (01:26):
First podcast.
Amanda Knight (01:27):
And now the hosts of the podcast, amanda Knight
and Scott Gordon.
Scott Chip, thanks for joiningus today.
Scott Sheiblin (01:35):
Glad to be here .
Awesome Thanks for having us.
Scott Gordon (01:37):
Yeah, thank you guys for helping us out here.
So current research suggeststhat at least 12% of US adults
report using a GLP-1.
So let's start with a quickrecap of the basics.
I guess, Scott, can you brieflyexplain what GLP-1 medications
are and why their use isexploding right now.
(01:59):
Sure, sure.
Scott Sheiblin (02:01):
GLP-1 medications were initially
introduced for the treatment oftype 2 diabetes medications like
Ozempic and Wegovy and in sortof a happy coincidence, they
found that it was having a majorpositive effect on weight for
these patients.
Those medications help toprovide satiety and also
(02:25):
regulate blood sugar and such.
So out of that they have becomeincredibly popular
prescriptions for what is, youknow, an obesity epidemic in
this country, for weight control, and we're seeing that go
everywhere now.
That go everywhere now.
That goes across specialtiesfrom primary care physicians to
(02:53):
you know you might have yourdermatologist want to provide it
to you.
It's in digital healthplatforms.
It has caused a explosion ofcompounding pharmacies doing it
because of a short supply of thebrand names.
I mean, anecdotally, watchingcollege football over the
weekend, I think I saw fourseparate commercials for this
stuff.
Amanda Knight (03:08):
Wow, chip, can you walk us through some of the
key risks for healthcareproviders that are now jumping
into the GLP-1 fray?
Chip Wienges (03:19):
Sure, the biggest risks we're seeing are improper
prescribing due to a lot oftraining, patient misuse of the
drugs, particularly compoundedversions and liability concerns
from adverse reactions.
There's a direct line betweenoff-label use of a medication
and misuse potential, and we'realso seeing increased regulatory
(03:41):
scrutiny and potential claimsfrom patients who may not be
properly monitored.
There are a lot of positives tothese drugs that have been well
documented, but there ispotential for negative outcomes.
You can start with your typicaldigestive issues, but we're
also starting to see acutekidney injury, suicidal ideation
(04:03):
, pancreatic and thyroid issues.
But we're also starting to seeacute kidney injury, suicidal
ideation, pancreatic and thyroidissues.
Some more serious issuespopping up, and those are just,
you know, obviously have thepotential to lead to more
serious crimes.
Scott Gordon (04:16):
So let's dive deeper into some of the
regulatory issues.
Scott, we've seen some FDAadvisories around compounded
versions of GLP-1s.
How do you see this impactingproviders?
Scott Sheiblin (04:30):
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 theproliferation of compounded
versions using, specifically,sodium versions and acetate
versions.
The FDA has been pretty clear.
The potential for adverseeffects out of that are there
(04:51):
and they're concerned about it.
Yet those are also the mostreadily available.
So where I see it impactingproviders is I see the potential
of insurance carriers to wantto rein that in.
You see it very much on the ENSside already where they're very
focused and want to ask thosequestions and I think that that
(05:12):
is going to continue across intothe admitted side as well,
where they're going to want toknow what version of this are
you prescribing, because anytimeyou have a version that the FDA
says we're concerned about, Ithink if you follow a linear
path of if that version leads toa claim, that's a pretty hard
defense to have you prescribesomething the FDA didn't say you
(05:35):
should prescribe.
Amanda Knight (05:40):
question I had in mind about you know are
insurers pulling back?
Are they pulling back oncompounded but not the original
versions?
Do you guys have any insight?
Chip Wienges (05:53):
Well, a lot of carriers are hesitant to cover
compounded GLP-1s because of theFDA warnings and the lack of
quality control.
When you use a third-partypharmacy, you don't know exactly
.
If you control and use athird-party pharmacy, you don't
know exactly.
You don't know every time whatyou're getting.
So we're seeing some carriersoutright exclude these
medications or limit thecoverage to the branded versions
(06:14):
, which creates challenges toproviders who need to offer
these treatments to theirpatients.
Amanda Knight (06:25):
If there are FDA advisories and there are some
clear issues.
We've already seen lawsuitsaround GLP-1s.
If I'm a physician and I don'tspecialize in, say,
endocrinology for diabetes careor obesity treatment, why am I
doing this?
Because of demand.
Scott Sheiblin (06:54):
Because the money to be made is just too
lucrative, like what is pullingphysicians in are being met with
patients who want thismedication.
They're being also met with theability to prescribe it and see
excellent margins, because thisis not insurance reimbursable at
that point with the compoundedmedications.
So there is a need and thatneed will find a way to get
(07:18):
filled.
The FDA has stepped in andgiven some caution to that.
Now, just to add as an extrapoint, again from a provider
perspective, that's where youalso want to be careful, because
do you as a provider becauseyou may never have actually had
to think about this as aendocrinologist or a primary
care provider prescribing amedication do you have an FDA
(07:42):
exclusionary wording on yourpolicy?
Do you have something in yourpolicy saying to you we will not
cover you for non-FDA approvedor off-brand FDA usage that are
under advisory, whatever thatmay be?
And I think that's somewhat ofthe risk that starts to be taken
on when you start to use thingsthat are under an FDA advisory,
(08:04):
that are in that compoundedversion and that's where you
know the compliance side ofthings can get scary for a
provider right now.
Amanda Knight (08:16):
Well, and we've already seen, like we said, some
lawsuits around GLP-1medications.
I did some research and thosedon't seem to be slowing down.
I know I read last week aboutseveral filed just based on side
effects alone.
Do we anticipate, based on that, that litigation is going to
(08:36):
continue to grow and be a biggerconcern for healthcare
providers in this space?
Chip Wienges (08:41):
Well numbers.
The more widespread you knowthe exposure, the more adverse
reactions and side effectsyou're going to have, and that's
obviously going to lead toincreased plant activity.
So pretty simple equation.
Amanda Knight (08:57):
Well, and it's also my understanding that these
have not been around for allthat long, so it's not like we
have a lot of historical data onthe long-term side of what
these side effects or thelong-term impact of using these
can be.
Scott Sheiblin (09:15):
Yeah, I think that's such an excellent point
On so many different levels.
That's an excellent pointbecause you don't have the
claims data to know what's goingto happen.
Yes, FDA approval has happenedon those medications.
So the FDA say on the brandaversion, it's okay, but you
(09:36):
don't know on the compoundaversion.
This is very, very new From aninsurance perspective.
I think the maximum ofinsurance is you make decisions
based upon the past, right,You're using the claims data and
you're using all of thatavailable to determine the go
forward of how you want to coversomething.
(09:56):
This is so new and exploded soquickly that that claims data
isn't there yet.
So I think we're in for acouple of years until that
figures itself out where thingsare going to change, and things
could monumentally change.
You could have the FDA couldcome out with another advisory
(10:17):
and specifically say thisformulation is very, very bad
and we shift to anotherformulation.
So it's shifting sands rightnow on this stuff.
Scott Gordon (10:25):
Well, and this this question made the answer to
this may change dramatically inthe future as well, but let's
talk about present day solutions.
What steps should healthcareproviders be taking right now to
help mitigate these kinds ofrisks?
Scott Sheiblin (10:40):
Yeah, I would say that you would probably want
to educate yourself as to thebest practices and procedures
that you can possibly follow ifyou're going to be prescribing
this.
For instance, have you done theblood work on an individual?
Have you measured their BMI?
You know what version are yougiving, what dosage are you
(11:01):
giving.
You know, are you givingozembic for weight loss, for
instance, versus?
I believe zep bound is the onethat is the sole FDA approved
specifically for weight loss.
So there's that side of things.
And then on the next sort ofside of it is okay, you follow
(11:22):
the best policies, proceduresyou can.
You determine what the risksare.
You're aware of things like theFDA advisory.
And then I think you need towork with your retail agent and
who should be there to advocatefor you to determine whether or
not your policy is going tocover in the potential of a
claim.
One thing I would say is thatthere is, I think, a belief out
(11:45):
there that this, because of thewidespread usage, this
proliferates across the board inthe books of many, many
insurers, and I think thatthere's validity to that, but
that doesn't mean that they'regoing to cover the claim.
You know, making thatassumption without an
affirmative is not the same ashaving an affirmative, and so I
(12:07):
would tell you, same as havingan affirmative, and so I would
tell you, especially if you'rein something where weight loss
or weight management may nothave been a particular thought
of this is what your practicewould be doing.
For instance, a dermatologistprescribing or I think we all
remember when Botox became verypopular, dentists started
providing Botox.
(12:27):
Do you know your policy isgoing to cover it?
Do you know your policy has anFDA exclusionary wording or not?
Those are things to protectyourself, because just because
it's all over doesn't mean whenthe rubber meets the road a
claim will get covered, andthat's where I would tell people
to be careful.
That's where I would reallycounsel insurance.
Chip Wienges (12:46):
And while you're on the do you know?
Subject, as a provider, do youknow the compounding pharmacy
that you're utilizing?
Do you know what kinds ofquality control measures they're
using?
Do you know how overwhelmedthey are?
Have you worked with thembefore?
There are all those questionsas well, because there's no
(13:07):
doubt there's a line between thecompounding pharmacy and the
provider, where you're leaningon them.
Scott Sheiblin (13:15):
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, theformulation was wrong.
The compound pharmacy is goingto be who's held responsible.
But to back to the original,you as a provider, did you check
that this patient should havethis medication.
Did you make certain of that?
(13:37):
Because that's where you know,even if it is a problem of the
medication, if you'represcribing something to someone
without doing the necessarychecks on somebody, without
having met a standard of carethat would make sense for
prescribing a medication of thisnature, you know you have the
potential of liability existing.
Even if the compoundingpharmacy is ultimately
(13:59):
responsible for the injury,you're at least contributing.
Amanda Knight (14:04):
I also.
I mean, I'm on social media,aren't we all?
But I've also noticed that youcan buy this stuff, like on the
internet, and they will ship itto your house and then you have
to give it to yourself.
Scott Sheiblin (14:17):
Yes.
Amanda Knight (14:17):
And I feel like there's got to be some liability
there via, like, maybe thatcounts as telemedicine or
something.
Scott Sheiblin (14:26):
Well, there's the telemedicine part of it
about.
You know, are you prescribingacross state lines?
Do you have the properlicensure?
There's all traditionaltelemedicine things that have to
do with that.
And then there's the addedcomponent of how much counseling
and how much actual instructionhave you given to a patient.
I mean, I'll give you a coupleof examples.
(14:48):
Patient takes 0.5 millilitersof this and says, you know, I
lost a pound or I was still kindof hungry.
Well, I'm going to go ahead andtake 1.5, because what the heck
, and you know, 0.5 worked okay,1.5 should work three times
better.
Well, was there propercounseling, instruction plan to
(15:11):
that person to make clear youcannot do that, even you know,
yes, sticking yourself with aninsulin needle from the vial
that they give you and draw, youknow.
Again, I don't want to minimize, but may not be likely to cause
a severe claim.
However, you can still dosomething.
You can still screw it up.
(15:33):
Was there a video that showedyou how to do things?
Just letting people have thisstuff and then not having either
done it on the front end interms of evaluation and also
instruction as to how toactually administer the proper
dosages and things, and alsoinstruction as to how to
actually administer the properdosages and things.
You're just piling up bricks tomake it look like you have more
(15:54):
and more liability at your feet.
Amanda Knight (15:57):
In the process of writing the article we put
together, I read about one ladywho just there was a video but
it didn't match the writteninstructions and somehow she
gave herself like five times theprescribed dose and then her
husband picked it up and he waslike uh, I think that was too
much, and you know she ends upin the hospital and-.
Scott Sheiblin (16:17):
An attorney may argue what why'd you send her
all that?
Can't you send it to her everyweek in the just the dosage you
need?
You send her an entire vialthat lasts a month, as opposed
to an individual.
You know that's some of whatexists in terms of liability
from those compounded versions.
(16:37):
That is very different from thebranded versions.
Part of the branded versions,beyond formulation, that is
different is the actual deliverymethod.
It's a method that is made sothat 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 workagain.
Amanda Knight (16:56):
Right.
Scott Sheiblin (16:57):
When you're using the compound versions and
you are sending out this inlarger dosage with a bag of
needles— which is what happensand maybe a QR code you may not
be seen by some as meeting thestandard of care you needed to.
That's a hypothetical, but youjust may not.
Amanda Knight (17:17):
Like either way, let's document exactly what we
told people, because they'realso going to YouTube and just
watching other people's socialmedia content and making
decisions about how much to givethemselves based on that,
whether or not it's right orwrong.
If you've documented this isexactly how much I have advised
this person.
(17:38):
Then at least it shows that youwere very clear.
Scott Sheiblin (17:41):
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 togo to TikTok and say, well, this
is you know how X celebritylost this amount of weight.
And they followed it and theythey throw out the regular
instructions that they weregiven, which were maybe brief,
(18:02):
and try something completelydifferent.
So, yeah, I think potentialsfor especially the delivery that
kind of thing was, you know,help some of the teleplatforms
is a little bit.
It has sense to partner withCRC.
Healthcare has provided fordecades and the strength of our
(18:56):
collective healthcare group andI think to a certain extent the
evidence is things like this.
It is that the healthcare grouptries to identify where new
exposures, where new problemsfor our retail agents are going
to exist, and work with them tofind solutions.
You know, this is a very newproblem and this is a very new,
(19:19):
or I should say, exposure thatcan create new problems.
And we're trying to beproactive with our retailers so
that they don't have to be ontheir back foot.
We're going to do the work tofigure so that they don't have
to be on their back foot.
We're going to do the work tofigure out how to get this done
for you now so that we can helpyou, and I think that's what we
try to do at CRC Healthcare.
Amanda Knight (19:38):
What do you think Chip Did?
He say it all beautifully.
Chip Wienges (19:41):
He pretty much said it all.
It's not only the proactivitywith the retail agents, it's the
proactivity with the carriersas well.
We've got access to the entiremarketplace and we have been
sending surveys, asking thesequestions, for months now, and
(20:02):
so the breadth of informationthat we're able to compile and
then pass along to our agents,you know it's, it's pretty large
.
Amanda Knight (20:11):
Well, I think you guys have made it through the
hard part.
Scott, what's next?
Scott Gordon (20:16):
Oh man.
The next is a little segment welike to call rapid fire, and
this is where we just asked youguys some rando questions or
maybe not so rando and try tojust get the first thing that
comes to your mind.
So the first question if youweren't in the insurance world,
what's a completely differentcareer that you could see
(20:39):
yourself pursuing?
Scott Sheiblin (20:40):
Chip is going to have such a cooler answer
than I am.
I know it.
Chip Wienges (20:43):
No, I'm not.
In fact I'm trying to removemyself from the insurance world,
but I can't do it completelybecause I think that I would go
back, get a law degree and gointo med companies.
I don't think that'stechnically insurance, but I've
always had so much just basicawe and respect for the
attorneys that defend theseclaims and defend these clients,
(21:06):
and that would just be amazing.
Scott Sheiblin (21:09):
Well, you stole that answer, so I can't use
that now.
So, all right.
So myself, over the last coupleof years, I've developed a
problem hoarding houseplants.
The exact number is unknown atthis point, so I think I would
(21:34):
we're.
It's getting bad.
I'm almost to the point oflearning their latin name.
So it's getting bad, uh, so Ithink I would try to, uh, I
think I try to hang a shingleand and sell my plants well, not
my plants.
Amanda Knight (21:45):
Sell other people's plants your plants are
like family members.
You can't do that.
Scott Sheiblin (21:48):
Yeah, I've named them, so they can't leave.
Amanda Knight (21:53):
I like it.
Scott Gordon (21:54):
Ironically and those people listening can't see
this but Chip is the one withthe plants in the background.
I know you're in the office,scott, but there you go.
Amanda Knight (22:01):
Yeah.
Scott Gordon (22:04):
Everybody loves a good plant, so our next question
Last one yeah, so our nextquestion, last one yeah, there's
only two.
I'm sorry.
I know we wish this could go onforever.
If you could travel anywhere inthe world right now, where
would you go and why?
Chip Wienges (22:19):
Fresh on my mind, I would go straight back to
where I was this weekend.
My wife and my daughter and Iwent down to Franklin, tennessee
, for a music festival.
We go pretty much everyTennessee for a music festival.
We go pretty much every yearpilgrimage music festival.
We had such a profoundlyamazing time this weekend.
I go right back there and Iwill for the next as long as
(22:40):
that festival will be there.
Scott Sheiblin (22:42):
That's good.
I would go to Ireland.
I love a place where you canwear a chunky wool sweater and I
put on one of those caps andnot feel like a dork.
I think in Ireland it's okay.
So it's my dream.
Amanda Knight (22:57):
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 (23:02):
I probably can't go to Ireland and say, hey
, can you give me one of yourdorky hats?
That's probably not the way toRight International relations,
not good that way.
Amanda Knight (23:09):
I wonder you'd have to look up the customs
rules.
Can you bring home any Irishplants is the question.
Scott Sheiblin (23:15):
Well, I mean, now we're figuring out my
retirement plan.
Scott Gordon (23:19):
Right, it's all just a bunch of moss anyway
Sounds fantastic.
Yeah, and grass grass for thesheep.
Well, thanks, scott and Chip.
This has been great.
Thanks for sharing yourinsights and being such good
sports.
We never expected talking aboutdiabetes or weight loss to be
this much fun, but there you go.
(23:40):
Thank you guys.
Thanks guys.
Amanda Knight (23:42):
And for all of our listeners.
If you want to learn more orneed help navigating these risks
, please be sure to reach out tothe CRC Group Healthcare team.
We'll see you all next time.
Welcome back to the CRC Group podcast.
Today we're diving deeper intoone of the hottest topics facing
healthcare providers right nowGLP-1 medications.
These drugs are shaking up theworld of diabetes and obesity
treatment, but as their useskyrockets, so do the risks for
healthcare professionals.
Scott, I think that you canagree with me.
(00:23):
This is something we've beenhearing more and more about in
the healthcare insurance space.
Scott Gordon (00:28):
Absolutely, and they seem to be everywhere.
While GLP-1s do offergroundbreaking results for
patients, they also represent aunique set of challenges,
especially when it comes toliability, safety and coverage
gaps for healthcare providers.
And, lucky for our listeners,today we've got two great CRC
(00:49):
healthcare brokers with us tohelp break it all down.
Amanda Knight (00:53):
We're thrilled to welcome Scott Scheiblin and
Chip Wenges, two seasonedhealthcare brokers with CRC
Denver, who are on the frontlines of helping retail agents
and their clients navigate theemerging risks tied to GLP-1s.
This is the Placing you Firstpodcast from CRC Group.
Scott Gordon (01:11):
This podcast features news and insights from
a vast knowledge base of over5,100 associates.
Amanda Knight (01:17):
Who write more than $35 billion in premium
annually.
Plus, we give you the latestinformation on what's happening
at CRC.
Scott Sheiblin (01:24):
This is the Placing you.
Scott Gordon (01:26):
First podcast.
Amanda Knight (01:27):
And now the hosts of the podcast, amanda Knight
and Scott Gordon.
Scott Chip, thanks for joiningus today.
Scott Sheiblin (01:35):
Glad to be here .
Awesome Thanks for having us.
Scott Gordon (01:37):
Yeah, thank you guys for helping us out here.
So current research suggeststhat at least 12% of US adults
report using a GLP-1.
So let's start with a quickrecap of the basics.
I guess, Scott, can you brieflyexplain what GLP-1 medications
are and why their use isexploding right now.
(01:59):
Sure, sure.
Scott Sheiblin (02:01):
GLP-1 medications were initially
introduced for the treatment oftype 2 diabetes medications like
Ozempic and Wegovy and in sortof a happy coincidence, they
found that it was having a majorpositive effect on weight for
these patients.
Those medications help toprovide satiety and also
(02:25):
regulate blood sugar and such.
So out of that they have becomeincredibly popular
prescriptions for what is, youknow, an obesity epidemic in
this country, for weight control, and we're seeing that go
everywhere now.
That go everywhere now.
That goes across specialtiesfrom primary care physicians to
(02:53):
you know you might have yourdermatologist want to provide it
to you.
It's in digital healthplatforms.
It has caused a explosion ofcompounding pharmacies doing it
because of a short supply of thebrand names.
I mean, anecdotally, watchingcollege football over the
weekend, I think I saw fourseparate commercials for this
stuff.
Amanda Knight (03:08):
Wow, chip, can you walk us through some of the
key risks for healthcareproviders that are now jumping
into the GLP-1 fray?
Chip Wienges (03:19):
Sure, the biggest risks we're seeing are improper
prescribing due to a lot oftraining, patient misuse of the
drugs, particularly compoundedversions and liability concerns
from adverse reactions.
There's a direct line betweenoff-label use of a medication
and misuse potential, and we'realso seeing increased regulatory
(03:41):
scrutiny and potential claimsfrom patients who may not be
properly monitored.
There are a lot of positives tothese drugs that have been well
documented, but there ispotential for negative outcomes.
You can start with your typicaldigestive issues, but we're
also starting to see acutekidney injury, suicidal ideation
(04:03):
, pancreatic and thyroid issues.
But we're also starting to seeacute kidney injury, suicidal
ideation, pancreatic and thyroidissues.
Some more serious issuespopping up, and those are just,
you know, obviously have thepotential to lead to more
serious crimes.
Scott Gordon (04:16):
So let's dive deeper into some of the
regulatory issues.
Scott, we've seen some FDAadvisories around compounded
versions of GLP-1s.
How do you see this impactingproviders?
Scott Sheiblin (04:30):
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 theproliferation of compounded
versions using, specifically,sodium versions and acetate
versions.
The FDA has been pretty clear.
The potential for adverseeffects out of that are there
(04:51):
and they're concerned about it.
Yet those are also the mostreadily available.
So where I see it impactingproviders is I see the potential
of insurance carriers to wantto rein that in.
You see it very much on the ENSside already where they're very
focused and want to ask thosequestions and I think that that
(05:12):
is going to continue across intothe admitted side as well,
where they're going to want toknow what version of this are
you prescribing, because anytimeyou have a version that the FDA
says we're concerned about, Ithink if you follow a linear
path of if that version leads toa claim, that's a pretty hard
defense to have you prescribesomething the FDA didn't say you
(05:35):
should prescribe.
Amanda Knight (05:40):
question I had in mind about you know are
insurers pulling back?
Are they pulling back oncompounded but not the original
versions?
Do you guys have any insight?
Chip Wienges (05:53):
Well, a lot of carriers are hesitant to cover
compounded GLP-1s because of theFDA warnings and the lack of
quality control.
When you use a third-partypharmacy, you don't know exactly
.
If you control and use athird-party pharmacy, you don't
know exactly.
You don't know every time whatyou're getting.
So we're seeing some carriersoutright exclude these
medications or limit thecoverage to the branded versions
(06:14):
, which creates challenges toproviders who need to offer
these treatments to theirpatients.
Amanda Knight (06:25):
If there are FDA advisories and there are some
clear issues.
We've already seen lawsuitsaround GLP-1s.
If I'm a physician and I don'tspecialize in, say,
endocrinology for diabetes careor obesity treatment, why am I
doing this?
Because of demand.
Scott Sheiblin (06:54):
Because the money to be made is just too
lucrative, like what is pullingphysicians in are being met with
patients who want thismedication.
They're being also met with theability to prescribe it and see
excellent margins, because thisis not insurance reimbursable at
that point with the compoundedmedications.
So there is a need and thatneed will find a way to get
(07:18):
filled.
The FDA has stepped in andgiven some caution to that.
Now, just to add as an extrapoint, again from a provider
perspective, that's where youalso want to be careful, because
do you as a provider becauseyou may never have actually had
to think about this as aendocrinologist or a primary
care provider prescribing amedication do you have an FDA
(07:42):
exclusionary wording on yourpolicy?
Do you have something in yourpolicy saying to you we will not
cover you for non-FDA approvedor off-brand FDA usage that are
under advisory, whatever thatmay be?
And I think that's somewhat ofthe risk that starts to be taken
on when you start to use thingsthat are under an FDA advisory,
(08:04):
that are in that compoundedversion and that's where you
know the compliance side ofthings can get scary for a
provider right now.
Amanda Knight (08:16):
Well, and we've already seen, like we said, some
lawsuits around GLP-1medications.
I did some research and thosedon't seem to be slowing down.
I know I read last week aboutseveral filed just based on side
effects alone.
Do we anticipate, based on that, that litigation is going to
(08:36):
continue to grow and be a biggerconcern for healthcare
providers in this space?
Chip Wienges (08:41):
Well numbers.
The more widespread you knowthe exposure, the more adverse
reactions and side effectsyou're going to have, and that's
obviously going to lead toincreased plant activity.
So pretty simple equation.
Amanda Knight (08:57):
Well, and it's also my understanding that these
have not been around for allthat long, so it's not like we
have a lot of historical data onthe long-term side of what
these side effects or thelong-term impact of using these
can be.
Scott Sheiblin (09:15):
Yeah, I think that's such an excellent point
On so many different levels.
That's an excellent pointbecause you don't have the
claims data to know what's goingto happen.
Yes, FDA approval has happenedon those medications.
So the FDA say on the brandaversion, it's okay, but you
(09:36):
don't know on the compoundaversion.
This is very, very new From aninsurance perspective.
I think the maximum ofinsurance is you make decisions
based upon the past, right,You're using the claims data and
you're using all of thatavailable to determine the go
forward of how you want to coversomething.
(09:56):
This is so new and exploded soquickly that that claims data
isn't there yet.
So I think we're in for acouple of years until that
figures itself out where thingsare going to change, and things
could monumentally change.
You could have the FDA couldcome out with another advisory
(10:17):
and specifically say thisformulation is very, very bad
and we shift to anotherformulation.
So it's shifting sands rightnow on this stuff.
Scott Gordon (10:25):
Well, and this this question made the answer to
this may change dramatically inthe future as well, but let's
talk about present day solutions.
What steps should healthcareproviders be taking right now to
help mitigate these kinds ofrisks?
Scott Sheiblin (10:40):
Yeah, I would say that you would probably want
to educate yourself as to thebest practices and procedures
that you can possibly follow ifyou're going to be prescribing
this.
For instance, have you done theblood work on an individual?
Have you measured their BMI?
You know what version are yougiving, what dosage are you
(11:01):
giving.
You know, are you givingozembic for weight loss, for
instance, versus?
I believe zep bound is the onethat is the sole FDA approved
specifically for weight loss.
So there's that side of things.
And then on the next sort ofside of it is okay, you follow
(11:22):
the best policies, proceduresyou can.
You determine what the risksare.
You're aware of things like theFDA advisory.
And then I think you need towork with your retail agent and
who should be there to advocatefor you to determine whether or
not your policy is going tocover in the potential of a
claim.
One thing I would say is thatthere is, I think, a belief out
(11:45):
there that this, because of thewidespread usage, this
proliferates across the board inthe books of many, many
insurers, and I think thatthere's validity to that, but
that doesn't mean that they'regoing to cover the claim.
You know, making thatassumption without an
affirmative is not the same ashaving an affirmative, and so I
(12:07):
would tell you, same as havingan affirmative, and so I would
tell you, especially if you'rein something where weight loss
or weight management may nothave been a particular thought
of this is what your practicewould be doing.
For instance, a dermatologistprescribing or I think we all
remember when Botox became verypopular, dentists started
providing Botox.
(12:27):
Do you know your policy isgoing to cover it?
Do you know your policy has anFDA exclusionary wording or not?
Those are things to protectyourself, because just because
it's all over doesn't mean whenthe rubber meets the road a
claim will get covered, andthat's where I would tell people
to be careful.
That's where I would reallycounsel insurance.
Chip Wienges (12:46):
And while you're on the do you know?
Subject, as a provider, do youknow the compounding pharmacy
that you're utilizing?
Do you know what kinds ofquality control measures they're
using?
Do you know how overwhelmedthey are?
Have you worked with thembefore?
There are all those questionsas well, because there's no
(13:07):
doubt there's a line between thecompounding pharmacy and the
provider, where you're leaningon them.
Scott Sheiblin (13:15):
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, theformulation was wrong.
The compound pharmacy is goingto be who's held responsible.
But to back to the original,you as a provider, did you check
that this patient should havethis medication.
Did you make certain of that?
(13:37):
Because that's where you know,even if it is a problem of the
medication, if you'represcribing something to someone
without doing the necessarychecks on somebody, without
having met a standard of carethat would make sense for
prescribing a medication of thisnature, you know you have the
potential of liability existing.
Even if the compoundingpharmacy is ultimately
(13:59):
responsible for the injury,you're at least contributing.
Amanda Knight (14:04):
I also.
I mean, I'm on social media,aren't we all?
But I've also noticed that youcan buy this stuff, like on the
internet, and they will ship itto your house and then you have
to give it to yourself.
Scott Sheiblin (14:17):
Yes.
Amanda Knight (14:17):
And I feel like there's got to be some liability
there via, like, maybe thatcounts as telemedicine or
something.
Scott Sheiblin (14:26):
Well, there's the telemedicine part of it
about.
You know, are you prescribingacross state lines?
Do you have the properlicensure?
There's all traditionaltelemedicine things that have to
do with that.
And then there's the addedcomponent of how much counseling
and how much actual instructionhave you given to a patient.
I mean, I'll give you a coupleof examples.
(14:48):
Patient takes 0.5 millilitersof this and says, you know, I
lost a pound or I was still kindof hungry.
Well, I'm going to go ahead andtake 1.5, because what the heck
, and you know, 0.5 worked okay,1.5 should work three times
better.
Well, was there propercounseling, instruction plan to
(15:11):
that person to make clear youcannot do that, even you know,
yes, sticking yourself with aninsulin needle from the vial
that they give you and draw, youknow.
Again, I don't want to minimize, but may not be likely to cause
a severe claim.
However, you can still dosomething.
You can still screw it up.
(15:33):
Was there a video that showedyou how to do things?
Just letting people have thisstuff and then not having either
done it on the front end interms of evaluation and also
instruction as to how toactually administer the proper
dosages and things, and alsoinstruction as to how to
actually administer the properdosages and things.
You're just piling up bricks tomake it look like you have more
(15:54):
and more liability at your feet.
Amanda Knight (15:57):
In the process of writing the article we put
together, I read about one ladywho just there was a video but
it didn't match the writteninstructions and somehow she
gave herself like five times theprescribed dose and then her
husband picked it up and he waslike uh, I think that was too
much, and you know she ends upin the hospital and-.
Scott Sheiblin (16:17):
An attorney may argue what why'd you send her
all that?
Can't you send it to her everyweek in the just the dosage you
need?
You send her an entire vialthat lasts a month, as opposed
to an individual.
You know that's some of whatexists in terms of liability
from those compounded versions.
(16:37):
That is very different from thebranded versions.
Part of the branded versions,beyond formulation, that is
different is the actual deliverymethod.
It's a method that is made sothat 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 workagain.
Amanda Knight (16:56):
Right.
Scott Sheiblin (16:57):
When you're using the compound versions and
you are sending out this inlarger dosage with a bag of
needles— which is what happensand maybe a QR code you may not
be seen by some as meeting thestandard of care you needed to.
That's a hypothetical, but youjust may not.
Amanda Knight (17:17):
Like either way, let's document exactly what we
told people, because they'realso going to YouTube and just
watching other people's socialmedia content and making
decisions about how much to givethemselves based on that,
whether or not it's right orwrong.
If you've documented this isexactly how much I have advised
this person.
(17:38):
Then at least it shows that youwere very clear.
Scott Sheiblin (17:41):
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 togo to TikTok and say, well, this
is you know how X celebritylost this amount of weight.
And they followed it and theythey throw out the regular
instructions that they weregiven, which were maybe brief,
(18:02):
and try something completelydifferent.
So, yeah, I think potentialsfor especially the delivery that
kind of thing was, you know,help some of the teleplatforms
is a little bit.
It has sense to partner withCRC.
Healthcare has provided fordecades and the strength of our
(18:56):
collective healthcare group andI think to a certain extent the
evidence is things like this.
It is that the healthcare grouptries to identify where new
exposures, where new problemsfor our retail agents are going
to exist, and work with them tofind solutions.
You know, this is a very newproblem and this is a very new,
(19:19):
or I should say, exposure thatcan create new problems.
And we're trying to beproactive with our retailers so
that they don't have to be ontheir back foot.
We're going to do the work tofigure so that they don't have
to be on their back foot.
We're going to do the work tofigure out how to get this done
for you now so that we can helpyou, and I think that's what we
try to do at CRC Healthcare.
Amanda Knight (19:38):
What do you think Chip Did?
He say it all beautifully.
Chip Wienges (19:41):
He pretty much said it all.
It's not only the proactivitywith the retail agents, it's the
proactivity with the carriersas well.
We've got access to the entiremarketplace and we have been
sending surveys, asking thesequestions, for months now, and
(20:02):
so the breadth of informationthat we're able to compile and
then pass along to our agents,you know it's, it's pretty large
.
Amanda Knight (20:11):
Well, I think you guys have made it through the
hard part.
Scott, what's next?
Scott Gordon (20:16):
Oh man.
The next is a little segment welike to call rapid fire, and
this is where we just asked youguys some rando questions or
maybe not so rando and try tojust get the first thing that
comes to your mind.
So the first question if youweren't in the insurance world,
what's a completely differentcareer that you could see
(20:39):
yourself pursuing?
Scott Sheiblin (20:40):
Chip is going to have such a cooler answer
than I am.
I know it.
Chip Wienges (20:43):
No, I'm not.
In fact I'm trying to removemyself from the insurance world,
but I can't do it completelybecause I think that I would go
back, get a law degree and gointo med companies.
I don't think that'stechnically insurance, but I've
always had so much just basicawe and respect for the
attorneys that defend theseclaims and defend these clients,
(21:06):
and that would just be amazing.
Scott Sheiblin (21:09):
Well, you stole that answer, so I can't use
that now.
So, all right.
So myself, over the last coupleof years, I've developed a
problem hoarding houseplants.
The exact number is unknown atthis point, so I think I would
(21:34):
we're.
It's getting bad.
I'm almost to the point oflearning their latin name.
So it's getting bad, uh, so Ithink I would try to, uh, I
think I try to hang a shingleand and sell my plants well, not
my plants.
Amanda Knight (21:45):
Sell other people's plants your plants are
like family members.
You can't do that.
Scott Sheiblin (21:48):
Yeah, I've named them, so they can't leave.
Amanda Knight (21:53):
I like it.
Scott Gordon (21:54):
Ironically and those people listening can't see
this but Chip is the one withthe plants in the background.
I know you're in the office,scott, but there you go.
Amanda Knight (22:01):
Yeah.
Scott Gordon (22:04):
Everybody loves a good plant, so our next question
Last one yeah, so our nextquestion, last one yeah, there's
only two.
I'm sorry.
I know we wish this could go onforever.
If you could travel anywhere inthe world right now, where
would you go and why?
Chip Wienges (22:19):
Fresh on my mind, I would go straight back to
where I was this weekend.
My wife and my daughter and Iwent down to Franklin, tennessee
, for a music festival.
We go pretty much everyTennessee for a music festival.
We go pretty much every yearpilgrimage music festival.
We had such a profoundlyamazing time this weekend.
I go right back there and Iwill for the next as long as
(22:40):
that festival will be there.
Scott Sheiblin (22:42):
That's good.
I would go to Ireland.
I love a place where you canwear a chunky wool sweater and I
put on one of those caps andnot feel like a dork.
I think in Ireland it's okay.
So it's my dream.
Amanda Knight (22:57):
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 (23:02):
I probably can't go to Ireland and say, hey
, can you give me one of yourdorky hats?
That's probably not the way toRight International relations,
not good that way.
Amanda Knight (23:09):
I wonder you'd have to look up the customs
rules.
Can you bring home any Irishplants is the question.
Scott Sheiblin (23:15):
Well, I mean, now we're figuring out my
retirement plan.
Scott Gordon (23:19):
Right, it's all just a bunch of moss anyway
Sounds fantastic.
Yeah, and grass grass for thesheep.
Well, thanks, scott and Chip.
This has been great.
Thanks for sharing yourinsights and being such good
sports.
We never expected talking aboutdiabetes or weight loss to be
this much fun, but there you go.
(23:40):
Thank you guys.
Thanks guys.
Amanda Knight (23:42):
And for all of our listeners.
If you want to learn more orneed help navigating these risks
, please be sure to reach out tothe CRC Group Healthcare team.
We'll see you all next time.
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