“Challenges for State Medicaid Due to Rising Prices of Weight Loss Drugs”
States are facing difficulties in affording popular GLP-1 drugs such as Wegovy, Ozempic, and Zepbound, leading to a search for solutions to alleviate the unexpected budget strains. One possible approach policymakers are considering is limiting the use of expensive diabetes medications for weight loss purposes among Medicaid recipients. Pennsylvania, for instance, is forecasted to spend $1.3 billion on Medicaid coverage for these drugs in 2025, a significant increase compared to previous years, contributing to a substantial budget deficit. The state is contemplating requirements for Medicaid patients seeking GLP-1s for weight loss, such as meeting certain body mass index criteria, trying diet and exercise programs, or using more affordable medications initially.
Dr. Val Arkoosh, Pennsylvania’s human services secretary, acknowledged the high cost of these medications during a state House hearing in March, noting their popularity and expense. While 14 states already cover GLP-1 drugs for obesity treatment under Medicaid, lawmakers in several other states are considering similar bills, with varying outcomes. Some states have halted programs due to cost concerns, like West Virginia and North Carolina, while others, such as Connecticut, are contemplating discontinuing Medicaid coverage for weight loss drugs altogether. Medicaid spending on GLP-1 drugs has surged, with reported costs reaching $3.9 billion in 2023, representing a significant increase from previous years.
Although a recent poll showed mixed opinions on Medicare and Medicaid covering weight loss drugs for individuals with obesity, Medicare currently does not include GLP-1s in its coverage. The Trump administration rejected a proposed rule by President Biden to extend coverage under Medicare’s Part D prescription drug plan, citing high costs. States that offer coverage have implemented strategies like prescription limitations to manage expenses. Advocates suggest that weight loss achieved with these drugs could lead to better health outcomes and reduced healthcare costs for Medicaid patients.
States are being encouraged to offer coverage for certain medications. It is emphasized that the need for long-term medication use is uncertain, posing a significant cost concern. About 40% of adults in the U.S. are affected by obesity, which can lead to various health issues. Medicaid often covers GLP-1 medications, which are used by some non-diabetics for weight loss. However, concerns about cost and side effects have been raised by experts. The debate over Medicaid coverage is happening at a time when budgets are strained, and federal funding cuts are being considered. Some states, like Connecticut, are facing deficits and considering changes to medication coverage requirements. Patients have shared their experiences with different medications, highlighting the importance of access to effective treatments for obesity.
