Friday Shorts and follow ups: Wegovy for liver disease, insurer-provider negotiations, measles and student loan debt
September 5, 2025
A. Semaglutide approved for MASH liver disease
Semaglutide (Wegovy) has obtained FDA approval for treatment of MASH, metabolic associated steatohepatitis, previously known as non-alcoholic fatty liver disease. MASH is common, affecting as much as 5% of the population, and can lead to cirrhosis, liver failure, and require liver transplantation. The only previous drug approved for this condition is resmetirom (Rezdiffra), which has a list price of about $48,000.
Here is a post from this spring on the study that demonstrated that semaglutide was effective in treatment of MASH, and an earlier post on bariatric surgery to treat MASH.
B. Hospital-insurer negotiations leave patients in the middle
KFF Health News reported this week that hospital systems and insurers are increasingly getting to “no” in negotiations. This means that large health systems go out of plan, leaving their patients to pay high out of plan rates or to travel long distances to receive specialty care. Here’s a paragraph that caught my attention:
…18% of non-federal hospitals experienced at least one documented case of public brinksmanship with an insurance company from June 2021 to May 2025... Over the same period, 8% of hospitals ultimately went out-of-network with an insurer, at least for a time.
There’s no easy answer to this problem. Providers continue to consolidate, which gives them additional negotiating leverage. Consolidation in health care could increase further as the Administration revoked a previous executive order to promote competition. Providers are also looking to increase margin now to soften the blow from large losses in revenue from Medicaid cuts that will start late next year.
Health plan premiums are rising at the steepest rate in over 15 years, and negotiations that increase hospital payments will make this worse. Further, when high leverage health care systems obtain high rates, they are better able to outcompete their lower priced rivals for high margin business, dealing a further blow to competition. Regulations that protect patients from high out-of-pocket costs from these failed negotiations might address the problems of care continuity and high patient bills, but would increase the costs of premiums as insurance plans would be forced to pay full out-of-plan rates.
Employers and health plan members can expect continued difficult rate negotiations.
C.Measles epidemic over in Texas
US Measles Cases, 2000-2025
Source: Centers for Disease Control and Prevention, September 3, 2025
Texas has now not had a new case of measles diagnosed for over 42 days (two incubation periods), so the measles epidemic in Texas is now over. Sporadic cases of measles are still being diagnosed around the country. Adults and children are well protected by two doses of MMR vaccine (measles, mumps and rubella), and adults who are uncertain of their immune status can either get vaccinated or have a blood test to determine if they are immune.
C. Almost one in three adolescents have pre-diabetes
The Centers for Disease Control and Prevention (CDC) released data this summer that showed that 32.7% of adolescents from ages 12 to 17 have hemoglobin A1C results that show “prediabetes.” This data is gathered from the National Health and Nutrition Examination Study (NHANES) results from 2022-2023, and is an increase from the previous time period. NHANES does complete examinations including blood tests of a nationally representative group of U.S. residents, and these data are especially useful in assessing public health needs. Extrapolated to the U.S. population, this means that about 8.4 million teens have prediabetes.
Not everyone with prediabetes will eventually get Type 2 diabetes, and those with prediabetes will often revert to normal HbA1C tests if they lose weight or take metformin, a drug that can delay or prevent the onset of diabetes.
D. Many are behind on student loan repayments
Bloomberg News reports that as of May 30% of student loan borrowers whose repayments were paused during the pandemic were at least 90 days behind in their repayments, and only one-third had begun payments at all. Over 2 million borrowers had their credit score drop by over 100 points. The recent budget reconciliation bill (HR 1 -OBBB) made tax deductibility for employer student loan repayment programs permanent, so interest in these programs is likely to increase. Here’s a post on this from February.